NEWPORT BEACH, Calif., Dec. 17, 2013 /PRNewswire/ -- Best available technology to preserve postop brain function largely unused. Public needlessly traumatized about anesthesia awareness. Patients facing surgery MUST become proactive BEFORE surgery.
A recent NY Times article needlessly fanned public fears about exceedingly rare anesthesia under-medication with awareness and erroneously claimed "...consciousness isn't something we can measure."
Certainly good to see this information: "The pain caused by a surgical incision may contribute to the risk of postoperative cognitive dysfunction."
One effectively blocks incisional pain with complete NMDA receptor block; i.e. 50 mg ketamine 3-5 minutes pre-incision. Dose independent of adult body weight!
One protects the brain from negative ketamine side effects with a stable brain level of propofol easily achieved with an incremental induction (http://www.youtube.com/watch?v=GlQ3Do3b3_I) & made numerically reproducible measuring BIS <75 with baseline EMG.
The problem for most of my anesthesia colleagues (& their patients) is a failure of vision...
If you fail to measure the organ we medicate (i.e. the cerebral cortex), you are already doomed to over-medicate your patients.
If you fail to trend the electrical activity of the frontalis muscle or EMG as a secondary trace to the bispectral (BIS) index, you fail to have a useful, real time monitor.
If you fail to respond to EMG spikes as if they were heart rate or blood pressure changes, you fail to optimize the use of the BIS.
At the recent Spring 2013 meeting of the California Society of Anesthesiologists (CSA), held at the St. Regis hotel in Dana Point, the Goldilocks Anesthesia Foundation exhibited the 'Work smarter, not harder poster; the book, 'Getting Over Going Under'& the US Congressional award president & founder, Dr. Barry Friedberg, received for his propofol ketamine technique's contribution to anesthesia safety for wounded troops in forward units.
Nearly 150 copies of 'Getting Over Going Under' were given out to attendees.
See comment by 'narkose'
Anesthesia awareness is not lethal but anesthesia over medication, the natural consequence of failing to monitor depth of anesthesia, IS, specifically to the tune of one American patient every day!
Li G, et al: Epidemiology of Anesthesia-related Mortality in the United States, 1999–2005. Anesthesiology 2009;110:759
By trending EMG as a secondary trace, one creates a real time BIS monitor. Responding to spikes in EMG activity as if they were HR or BP changes is the key.
We do not blame the automobile for the reckless drunk driver's deaths. By his own public admission, Conrad Murray was reckless by giving Jackson propofol & leaving the room.
Hundreds of millions of patients worldwide have safely received propofol because someone was watching them breathe & monitoring their oxygenation.
Many medically licensed practitioners, nurses & physicians alike, have learned how to safely give propofol by taking this online course @ conscious sedation to learn how to combine direct brain measurement with pulse oximetry.
Virtually every cosmetic surgery begins with the injection of epinephrine in lidocaine solution.
Epinephrine provides shrinkage of the blood vessels (vasoconstriction) that minimizes blood loss during surgery.
Lidocaine can provide adequate pain relief (analgesia).
Since both drugs are given in the same syringe, having observed vasoconstriction, the surgeon 'reasonably' concludes the problem must be in the level of sedation when the patient moves during surgery.
No surgery under anesthesia without a brain monitor