Outpatient Surgery Magazine

Like Dr. Pinkner ("How We Do Outpatient Abdominoplasty," November 2001), I have been doing anesthesia for outpatient abdominoplasty. I concur with his guidelines for patient selection but respectfully disagree with his contention that "the procedure is not conducive to IV anesthesia because muscle relaxation may be needed." The degree of muscle relaxation required to imprecate the rectus sheath is minimal according to my colleague, Nicanor Isse, MD. It is easily obtained by infiltrating the abdominal wall with 1,000-1,500 cc of tumescent solution.

Patients will lie motionless for the injection of the local anesthetic if a 50 mg bolus of ketamine is given two to three minutes prior to that injection. Ketamine hallucinations are avoided if the patient has IV propofol titrated to a bispectral (BIS) index of 70-75 before giving the ketamine bolus.

IV sedation maintains the patient's normal leg muscle tone, obviating the need for sequential compression stockings or mini-dose heparin. Patients do not usually receive more than 100-200 cc of IV fluid and are not usually catheterized in our office practice. Our patients are ready for discharge in less that an hour after surgery and they suffer no ill effects for not being kept in the offer longer as Dr. Pinkner recommends.

Barry L. Friedberg, MD
Chief Clinical Instructor in Anesthesia
University of Southern California
Los Angeles, CA