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March 2002 To the Editor: ABC's of Anesthesia This letter is in reference to Dr. Alan Marco's article in the January 2000 issue of Outpatient Surgery. Over the past ten years, using propofol ketamine anesthesia, I have had a 0.5% percent PONV rate in a population of nearly 3000 patients who experienced a previous 35 percent PONV rate without the use of antiemetics. My method works well for hernial surgery, arthroscopy, gynecologic laparoscopy, lithotripsy, and all cosmetic surgeries, ranging from abdominoplasty to sub-pectoral breast augmentation, to facelifts. Time is not a limiting factor, either. Regarding preemptive analgesia, blocking the nu receptors with opioids will not block the sensory input of the local anesthesia injection. In a decade of office-based experience, I have not had a single admission for either PONV or uncontrolled post-op pain. Optioids are scrupulously avoided and the result is an essentially zero PONV outcome. Finally, in regard to the BIS monitor, I strongly believe that is a valuable tool for the experienced anesthesia provider as well as less experienced providers. While it take a learning curve of 20-50 cases to master it, the BIS gives the experienced provider information available from no other source. Trending the EMG as a secondary trace gives the provider a real-time predictor of patient movement. Also, by reducing unnecessary drug usage, it speeds the case through the facility. More cases mean more income! Barry L. Friedberg, MD |
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Copyright© 2001- by Barry L. Friedberg, M.D., A.M.C.,
All Rights Reserved |
