Club Drug - In the Operating Room

Date Published: 
Sat, 2003-11-01

The popular club drug "Special K" is one of the most dangerous, yet fastest-growing drugs on the club scene. Emergency room visits caused by the drug have increased more than 10-fold from 1994 to 2000. However, the hallucinogen is also one of the fastest growing anesthetics in outpatient operating rooms, and some medical experts are convinced it may be the safest pain inhibitor for patients to receive during surgery.

Ketamine has been in the club scene since the 1980s and saw resurgence in the late 90s because of its PCP- and LSD-like hallucinogenic effects. But it has also been used as an anesthetic in veterinary offices and in special burn situations. And in the wake of a recent rash of anesthesia mishaps in outpatient settings, many doctors are now regularly turning to the controversial drug ketamine for cosmetic outpatient surgeries.

"Once a patient is put to sleep, the most popular drugs anesthesiologists use to deal with pain are narcotics -- medications like morphine, Demerol and fentanyl," says Dr. Barry Friedberg, leading California anesthesiologist and a pioneer of medical ketamine use. "But the narcotics most doctors use are what we call opioids, and they depress the patient's drive to breath as well as the laryngeal or life protecting reflexes. Not surprisingly, respiratory complications are the number-one cause of anesthetic mishaps in the office setting. Ketamine, on the other hand, supports the breathing drive and increases the life-preserving reflexes. It's also a bronchial dilator and helps open up the lungs."


Many doctors are still hesitant to embrace a drug with nicknames like "Special K" and "Vitamin K" and one that is associated with teen hospital visits and rave culture. However, Dr. Friedberg defends the drug's safety record stating, "In the 38 years ketamine has been used medically, there have been no reported incidences of deaths as a result of its clinical use. The same cannot be said for the commonly used narcotics."

Dr. Friedberg, considered by the medical community to be the founder of the propofol ketamine (PK) technique of anesthetizing patients, has come under fire for his use of a "street drug" for outpatient cosmetic surgery. But he notes that patients don't have the same hallucinations that club kids seek since the patients are unconscious. "No matter what the street users are feeling, the patient doesn't remember experiencing a thing."

And like many illegal drugs used outside the doctor's office, the serious danger lurks in kids not knowing the purity of the drug. "You can't compare the street and clinical uses of ketamine since the dosages and chemical make-ups are impossible for recreational users to test or regulate."


But more importantly, says Friedberg, is that use of ketamine doesn't pose the risk of physical addiction, which the narcotics presently used do. Critics may note that recreational users are getting psychologically addicted, but the same threat doesn't exist when used clinically since the unconscious patients do not experience the sensations to which others become hooked. In the rare instances where a patient has remembered a hallucination, there have been no documented cases where an addiction has resulted. It generally takes quite a few occurrences of hallucinations for a person to begin becoming psychologically dependent.

"Think of it like getting an x-ray in the dentist's office," says Dr. Friedberg. "Even if the lead vest failed, you would have to receive a fairly large amount of x-rays before you became at risk."

Dr. Friedberg is also a proponent of the drug because it acts on a completely different set of receptors than morphine, Demerol and fentanyl. "In lay terms, ketamine scrambles the incoming pain signal and patients, even if they were awake, would be unable to feel the pain," he says. "With the opioids most doctors use now, patients still feel pain; they just don't care about it."


Dr. Friedberg surged to the forefront of the anesthesia community in 1992 when he began using ketamine in conjunction with the sedative propofol. Propofol also poses fewer risks than it's commonly used counterpart, Valium, both because it is easier to regulate the dosage and because patients come out of their sedation quicker.

"The average outpatient cosmetic surgery lasts about two-and-a-half hours," says Dr. Friedberg. "If you sedate an individual that long with Valium, there's a good chance he or she will need yet another drug called Romazicon to reverse the effects. And when that patient finally does awaken, he or she is looking at a recovery time of a few hours and a 'hangover' time of one to three days. Propofol has a recovery time of a few minutes and no hangover."

But more importantly is that Propofol can be regulated. "With Valium and other tranquilizers, anesthesiologists can only measure a patient's level of sleep by monitoring heart rate and blood pressure, and research has shown that neither have very much to do with how knocked out a patient is," continues Dr. Friedberg. "Propofol can be measured using a device that monitors consciousness and brain activity during sedation, and that's the organ we are trying to medicate."

"It really concerns me because our profession is faced with both the terrifying situation of under-dosing a patient and having him or her wake up during surgery as well as overdosing, which can result in severe post-operative nausea or worse," says Dr. Friedberg. "And yet, most doctors and anesthesiologists don't make a change from Valium to propofol because of either a perceived high cost of the medicine or just plain inertia. I guarantee that if patients were aware that they had another option, they would spend a few extra dollars for an anesthesia they were sure to wake up from, but from which they wouldn't wake up a moment to soon."


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. He has lectured in the United States, Canada, Israel, Venezuela and the Dominican Republic in addition to being a clinical instructor in Anesthesia at the University of Southern California.

Dr. Barry Friedberg Newport Beach, CA Ph: 949-233-8845


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