Outpatient Surgery Magazine

ABC's of Anesthesia

This letter is in reference to Dr. Alan Marco's article in the January 2000 issue of Outpatient Surgery.

Over the past ten years, using propofol ketamine anesthesia, I have had a 0.5% percent PONV rate in a population of nearly 3000 patients who experienced a previous 35 percent PONV rate without the use of antiemetics. My method works well for hernial surgery, arthroscopy, gynecologic laparoscopy, lithotripsy, and all cosmetic surgeries, ranging from abdominoplasty to sub-pectoral breast augmentation, to facelifts. Time is not a limiting factor, either.

Regarding preemptive analgesia, blocking the nu receptors with opioids will not block the sensory input of the local anesthesia injection. In a decade of office-based experience, I have not had a single admission for either PONV or uncontrolled post-op pain. Optioids are scrupulously avoided and the result is an essentially zero PONV outcome.

Finally, in regard to the BIS monitor, I strongly believe that is a valuable tool for the experienced anesthesia provider as well as less experienced providers. While it take a learning curve of 20-50 cases to master it, the BIS gives the experienced provider information available from no other source. Trending the EMG as a secondary trace gives the provider a real-time predictor of patient movement. Also, by reducing unnecessary drug usage, it speeds the case through the facility. More cases mean more income!

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