Anesthesia & Analgesia

Dissociative Monitored Anesthesia Care
Not Cited

To the Editor:

The article by Sá Rêgo et al. (1) mentions ketamine but not dissociative anesthesia. In my opinion, they should have included the following references (2-7) with the other 172 cited in the article. Dissociative anesthesia is deep sedation with the intensification of laryngeal or "life-preserving reflexes" and is exempted in AB595, the current California law regulating office anesthesia (Sacramento bureaucrat responsible for administering AB595, personal communication, 1996). Dissociative anesthesia has been used in office plastic surgery for more than two decades.

As to midazolam premedication preceding propofol infusion, Oxorn et al.'s recent article (8) shows no significant reduction in propofol requirements for either induction or maintenance by adding midazolam premedication. Finally, to the issue of cost consideration, the use of room air and spontaneous ventilation with dissociative anesthesia obviates the need for an anesthesia machine. The capital acquisition as well as the maintenance costs of the anesthesia machine are eliminated. Eliminating inhaled anesthetics also eliminated a malignant hypothermia trigger, thereby eliminating the cost of stocking dantrolene.

Barry L Friedberg, MD
Society for Office Anesthesiologists
Newport Beach Ca 92663-1225