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Answering Amanda's questions on All Experts website about Goldilocks Anesthesia

I've been providing propofol ketamine anesthesia for the 19 years and the past 13 of them with BIS monitoring. I have also been publishing many articles, letters, and an entire book, 'Anesthesia in Cosmetic Surgery,' for the profession. Coming to grips with my own anesthesia fears for my hip replacement surgery, I wrote 'Getting Over Going Under, 5 things you must know before anesthesia,' for the general public to constructively deal with their anesthesia fears.

In 1993, I published that sleep doses of propofol given before ketamine prevent bad dreams, etc., from ketamine. The drugs are not mixed but used separately for specific effects. The ketamine can be thought of as the 'olive' in the propofol 'martini.' Everyone who has followed my paradigm has had no problems in patients receiving ketamine.

Narcotic use has been completely eliminated, not merely reduced, because patients only need Tylenol or Toradol for postoperative discomfort. This worked nicely for my own total hip replacement nearly 3 years ago.

The cost of the BIS sensor is $20. The monitor is a one-time expense amortized over many years of use. Cost is not substantial considering the benefits of avoiding the risks of over medication (delirium, dementia & death). Making the monitor truly useful does require using EMG as a secondary trace, a minor adjustment apparently unknown to many anesthesia providers.

The main reason to use propofol is that it is an anti-oxidant, unlike the commonly used inhalational anesthetics that raise markers of inflammation. As to measuring blood levels of propofol - this is not nearly as relevant as directly measuring its effect in the brain, something the BIS monitor does very well.

The BIS monitor also helps to tell the difference between spinal cord movement and brain originated movement. This difference permits the correct treatment for the movement. Spinal cord movement merely requires more local anesthesia. Brain movement requires more propofol.

As for postoperative nausea and vomiting, propofol ketamine was cited by Dr. Christian Apfel in 'Miller's Anesthesia,' (p. 2473) the # 1 anesthesia textbook as having the lowest published rate in high risk patients without the use of anti-emetics like Zofran. Apfel, the world PONV expert, further states, 'As long as emetogenic agents (narcotics and inhalational anesthetics are given, the use of anti-emetics is of limited utility.'

Recall is not the principle value of BIS monitoring. Giving respect to your individual differences in drug tolerance and elimination of the nefarious practice of routinely over medicating you are the greatest values of measuring your brain.

It is your right to demand nothing less than brain monitoring for your anesthesia, irregardless of whether you are young or old. Unless the anesthesiologist is presented with the financial loss of your surgery, you will not get your wish granted.

You must learn whether or not your brain will be directly monitored before lying on the gurney on your way to the operating room. Download 3 free letters from www.drbarryfriedberg.com to help you deal with this critically important issue.

Brain monitoring is the 21st century standard of anesthesia care. Remember, you have to live with the long term consequences of your short term anesthesia care.

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