Cosmetic Surgery Anesthesia
"SAFER, SIMPLER, BETTER & COST EFFECTIVE cosmetic surgery anesthesia is here today," says Dr. Barry L. Friedberg, developer of bispectral index (BIS) monitored propofol ketamine sedation, now trademarked as minimally invasive anesthesia (MIA).
The fundamental difference between cosmetic surgery and other surgery is there is no medical reason (indication) to perform it aside from post- mastectomy reconstruction," states Dr. Friedberg, author and editor of Cambridge University Press' ground-breaking "Anesthesia in Cosmetic Surgery."
Without medical reason for cosmetic surgery, no avoidable anesthesia risks are acceptable.
All cosmetic procedures can be performed under purely local anesthesia. However, most patients prefer not to hear, feel or remember their cosmetic surgery, a state commonly associated with general anesthesia (GA). The use of the BIS monitor produces information from the brain, the anesthesiologist's target organ. BIS permits anesthesia providers to assign numerical values to levels of sedation/anesthesia on a scale of 0-100.
The sleep portion of GA occurs at BIS 45-60. However, the patient can have the same experience with MIA at BIS 60-75 with 20-30% less drug in their body," claims Dr. Friedberg. Less drug means lesser trespass. Lesser trespass translates into greater safety.
Compared with general anesthesia that typically requires giving 12-15 medications, MIA only requires 2 medications. BIS monitors the first of the two medications, propofol, on the patient's brain. This knowledge enables the anesthesiologist to give custom tailored doses of propofol. Without this knowledge, the anesthesia provider is obliged to guess how much of the drug(s) to give. Clearly, measuring is better than guessing.
If propofol is given at BIS 60-75, ketamine can be given without historically reported side effects. Ketamine at BIS 60-75 prevents the patient from feeling the pain of the local anesthetic injection. This phenomenon is called pre-emptive analgesia.
Pre-emptive analgesia means Dr. Friedberg's patients have not required any narcotic medications for postoperative pain for the past ten years. By comparison, GA only prevents the patient from responding to the pain of the injection. Once the GA is turned off, the patient's brain has to deal with the pain signals it received while asleep. Post-operative pain with GA is commonly treated with narcotics. The side effects of narcotics include nausea and vomiting, decidedly intolerable especially for facelift and tummy tuck patients, in addition to depression of breathing, risk of inhaling stomach contents into the lungs (aspiration) and constipation.
Because MIA does not require an anesthesia machine and scavenging of exhaled gases, it is far less expensive than GA. Propofol is now available as a generic drug so there is no longer a cost advantage to GA.
The public must ask for SAFER, SIMPLER, BETTER & COST EFFECTIVE cosmetic surgery anesthesia for the surgical and anesthesia professions to change.
Dr. Friedberg is not employed by Aspect Medical Systems, makers of the BIS monitor. He is not a stockholder or a paid consultant. The opinions expressed herein are his professional opinion based on 10 years experience with BIS monitoring for cosmetic surgery.