Plastic & Reconstructive Surgery February 2008

It is difficult to perform surgery without anesthesia, so all plastic surgeons have some interest in this topic. Dr. Friedberg has specifically excluded oral and intravenous sedation given or directed by the surgeon; the book deals exclusively with anesthesia given and directed by an anesthesiologist. The book is written by and for anesthesiologists, with a primary emphasis on Dr. Friedberg’s approach of “Minimally Invasive Anesthesia.” This technique is a combination of premedication with clonidine followed by bispectral index (of EEG) monitoring of a propofol-ketamine intravenous anesthetic. His goal is to give the least amount of anesthesia to achieve sedation and amnesia. He believes that this leads to a faster recovery and discharge as well as a lower incidence of nausea and vomiting. An interesting component is the need for the surgeon to provide adequate local anesthesia. His admonition to anesthesiologists that they will not have success with his technique without having a working relationship with their surgeon, one that allows them to let the surgeon know that the patient needs more local anesthesia, provides some insight into the view an anesthesiologist has of surgeons and surgery. It is a reminder that any anesthetic technique that attempts to limit intravenous or inhaled agents is dependent on achieving local anesthesia. To this end, there are good chapters on lidocaine toxicity and nerve block techniques in the head and neck. Chapters on preanesthetic assessment and psychological aspects of cosmetic surgery should also interest plastic surgeons and are worth reading if you find that you have access to this text. Other chapters had little to offer a surgeon other than the issues, viewpoint, and understanding that anesthesiologists have when providing anesthesia for outpatient surgery.

This book is a worthwhile read for anyone who has a strong interest in the anesthetic management of outpatient surgery. The take-home message is that if you would like your patients to receive less medication, give them more or better local anesthetic. You could team up with your anesthesiologist to provide this if you have a working relationship with him or her. If you believe that surgery is surgery and anesthesia is anesthesia, this book is not for you.