Outpatient Surgery Magazine

Date Published: 
June 2002

Yasmine Iqbal
Outpatient Surgery Magazine

To the Editor,

The only shortcoming in Dr. Marco's recent PONV article(1) was failing to mention the possibility of using a low emetogenic anesthetic technique(2) to avoid creating the problem in the first place. According to his stratification of risk, my exclusively office based plastic surgery practice which is 80% female, the overwhelming majority of them non-smokers with 35% previous PONV, would be moderate to high risk. Avoiding the routine use of opioids as well as inhalational vapors, my ten year propofol ketamine experience has had 13 emetic events in 2,680 patients or a 0.5% PONV rate without the use of any prophylactic measures he suggests.

If a patient has had previous PONV, they are likely to be opioid sensitive. This is analogous to being a waiting bucket of gasoline. The routine use of ANY opioids is like the proverbial match into the gasoline. As I tell my patients, if you don't toss the match into the gasoline, you don't have to worry about which fire extinguisher(s) to use!

Yours for better outcomes,

Barry L. Friedberg, M.D.


1. Marc AP. How to fine tune your PONV regimen. Outpatient Surgery Magazine 2002;3:40.
2. Friedberg BL. Propofol ketamine technique: dissociative anesthesia for office surgery (a five year review of 1,2364 cases). Aesth Plast Surg 1999;23:70.

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