Patient survey indicates that more accurate anesthesia dosages may improve post-operative condition
NEWPORT BEACH, CA, July 30, 2002 – Patients listed vomiting – NOT pain – as the number one postoperative condition they would like to avoid, according to a recent study on anesthesia. And with the medical community citing over-anesthetizing as a frequent cause of such nausea, one California expert is encouraging his colleagues to adopt new technology that may allow anesthesiologists to more accurately administer dosages.
Despite the dangers of either under- or over-anesthetizing a patient, the device, which measures brain activity to determine the state of a patient's consciousness, is only being employed in 26% of hospital operating rooms. "It's really a concern because here is something that can greatly improve a patient's overall post-surgical experience," says Dr. Barry Friedberg, leading Newport Beach anesthesiologist. "We obviously don't want to undermedicate, but patients have indicated that they consider a fast and comfortable recovery to also be very important."
The device is called the Bispectral Index (BIS), which measures brain activity and consciousness during sedation. In the past, anesthesiologists have monitored heart rate and blood pressure."Keeping an eye on the heart is essential for assessing how the body is reacting to the anesthesia," continues Dr. Friedberg. "But the BIS allows us to monitor the organ we are trying to sedate – the brain. Hand in hand, the two methods allow us to better gauge the patient's state of sleep and overall health. It makes sense to add it to the operating room."
Dr. Friedberg is concerned, however, that many hospitals and clinics might be putting the bottom line before patient care. "The relentless focus on the cost of healthcare is causing administrators to make some decisions at the expense of patients," he says. "The reality is that allowing anesthesiologists to do their job as well as possible will ultimately reduce costs. If we can make the anesthesia dosage more accurate, the patient will recover quicker helping to eliminate unnecessarily lengthy or overnight stays."
Anesthesia is still not an exact science. "Traditionally, anesthesiologists would medicate a patient much like a person makes a pot of coffee," says Dr. Friedberg. "You measure six cups of water, then six spoonfuls of coffee ground and then you throw in an extra spoonful for the pot. BIS eliminates the extra one for the pot by providing information that allows for a more exact measure of medicine. An appropriate dosage hopefully leads to a more rapid recovery, and that's the whole point."
20 million patients undergo surgery with general anesthesia or deep sedation each year in the United States. Experts expect this number to have risen by the end of 2002 due to an increase in cosmetic surgeries following last September's tragedies. "Because people saw how uncertain life could be, they stopped putting off doing things for themselves, including elective beauty procedures," says Dr. Friedberg. "And that has lead to an increase in the number of people going under."
Barry L. Friedberg, MD is at the forefront of the field of anesthesiology and is the developer of the propofol ketamine (PK) technique designed to maximize patient safety by minimizing the degree to which patients need to be medicated. He has been published in more than a dozen journals and several textbooks, as well as the Web sites for the Society for Office Based Anesthesia (SOBA) and the Society for Ambulatory Anesthesia (SAMBA). He was the founder of the Society for Office Anesthesiologists (SOFA) in 1996, which later merged with SOBA, another non-profit, international society dedicated to improving patient safety through education.