Propofol Ketamine with Bispectral Index (BIS) Monitoring

doi:10.1017/CBO9780511547218.004

1 - Propofol Ketamine with Bispectral Index (BIS) Monitoring

from PART I - MINIMALLY INVASIVE ANESTHESIA (MIA)Ⓡ FOR MINIMALLY INVASIVE SURGERY

Published online by Cambridge University Press: 22 August 2009

Barry L. Friedberg M.D.

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Barry Friedberg

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Barry L. Friedberg M.D.: Affiliation:
Assistant Professor in Clinical Anesthesia, Keck School of Medicine, University of Southern California
Barry Friedberg: Affiliation:
Keck School of Medicine, University of Southern California

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Summary

INTRODUCTION

Anesthesiologists are trained to administer anesthesia for surgery. Elective cosmetic surgery is commonly performed in an office-based facility with patients discharged to home. However, elective cosmetic surgery differs from elective or emergency surgery in many substantial aspects (see Tables 1–1 and 1–2).

“Cosmetic surgery is almost always elective, and patients are almost always in good health. The patient, however, is willing to risk this good health (at least to a limited extent) in order to experience improvements in physical appearance, and perhaps more importantly, self-esteem, body image, and quality of life.”

There is no medical indication for elective cosmetic procedures, excluding breast reconstruction post-mastectomy. One may consider risk-benefit ratios of differing anesthetic regimens in medically indicated surgery. However, surgery without medical indication should not accept any avoidable risk. Halogenated inhalation anesthetics are triggering agents for malignant hyperthermia (MH), carry an increased risk of deep venous thrombosis with potential pulmonary embolism, and are emetogenic. If the patient is interested and the surgeon is willing, all cosmetic procedures can be performed under local only anesthesia. Therefore, any additional anesthetic agents should be subject to the highest justification.

Most patients desire some alteration of their level of consciousness from fully awake through completely asleep. Given that all known risks should be avoided, when possible, then which agents are best suited to the task, what monitors should be employed, and to what level of anesthesia should be administered (i.e., minimal sedation [“anxiolyis”], moderate [“conscious”] sedation, deep sedation, or general anesthesia [GA])? (See Appendix 1–1, Defining Anesthesia Levels).

Type: Chapter
Information: Anesthesia in Cosmetic Surgery , pp. 1 - 13

DOI: https://doi.org/10.1017/CBO9780511547218.004 [Opens in a new window]

Publisher: Cambridge University Press

Print publication year: 2007

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References

Goldwyn RM: Psychological aspects of plastic surgery: A surgeon's observations and reflections, in Sarwer, DB, Pruzinsky, T, Cash, TF, et al. (eds.), Psychological aspects of reconstructive and cosmetic plastic surgery. Philadelphia, Lippincott, Williams & Wilkins, 2006; p13.

www.mhaus.org

McDevitt, NB: Deep venous thrombosis prophylaxis. Plast Reconstr Surg 104: 1923, 1999.Google Scholar

Apfel, CC, Korttila, K, Abdalla, M, et al.: A factorial trial of six interventions for the prevention of PONV. N Engl J Med 350:2441, 2004.Google Scholar

Friedberg, BL: Minimally invasive anesthesia for minimally invasive surgery. Outpatient Surgery Magazine. Herrin Publishing Partners LP, Paoli, PA. 2:57, 2004.

Cullen, SC, Larson, CP: Essentials of Anesthetic Practice. Chicago, Year Book Medical Publishers, 1974; p82.

Laurito CE: Anesthesia provided at alternative sites, in Barasch, PG, Cullen, BF, Stoelting, RK (eds.), Clinical Anesthesia, 4th ed., Philadelphia, Lippincott, Williams & Wilkins, 2001; p1343.

Friedberg, BL: Propofol-ketamine technique, dissociative anesthesia for office surgery: A five-year review of 1,264 cases. Aesth Plast Surg 23:70, 1999.Google Scholar

Lofsky, AS: Deep venous thrombosis and pulmonary embolism in plastic surgery office procedures. The Doctors' Company Newsletter. Napa, CA, 2005. www.thedoctors.com/risk/specialty/anesthesiology/J4254.aspGoogle Scholar

Flaishon, R, Windsor, A, Sigl, J, et al.: Recovery of consciousness after thiopental or propofol. Anesthesiol 86:613, 1997.Google Scholar

www.aspectms.com/resources/bibliographies

Friedberg BL: Propofol ketamine anesthesia for cosmetic surgery in the office suite, chapter in Osborne, I (ed.), Anesthesia for Outside the Operating Room. International Anesthesiology Clinics. Baltimore, Lippincott, Williams & Wilkins, 41(2):39, 2003.

Monk, TG, Saini, V, Weldon, BC, et al.: Anesthetic management and one-year mortality after non-cardiac surgery. Anesth Analg 100:4, 2005.Google Scholar

Kersssens, C, Sebel, P: Relationship between hypnotic depth and post-operative C-reactive protein levels. Anesthesiol 105:A578, 2006.Google Scholar

Macario, A, Weinger, M, Truong, P, et al.: Which clinical outcomes are both common and important to avoid? The perspective of a panel of expert anesthesiologists. Anesth Analg 88:1085, 1999.Google Scholar

Macario, A, Weinger, M, Carney, K, et al.: Which clinical anesthesia outcomes are important to avoid? The perspective of patients. Anesth Analg 89:652, 1999.Google Scholar

White, PF: Prevention of postoperative nausea and vomiting—A multimodal solution to a persistent problem. N Engl J Med 350:2511, 2004.Google Scholar

Scuderi, PE, James, RL, Harris, L, et al.: Multimodal antiemetic management prevents early postoperative vomiting after outpatient laparoscopy. Anesth Analg 91:1408, 2000.Google Scholar

Vinnik, CA: An intravenous dissociation technique for outpatient plastic surgery: Tranquility in the office surgical facility. Plast Reconstr Surg 67:199, 1981.Google Scholar

Thompson, SWN, King, AE, Woolf, CJ: Activity-dependent changes in rat ventral horn neurons in vitro, summation of prolonged afferent evoked depolarizations produce a D-2-amino-5-phosphonovaleric acid sensitive windup. Eur J Neurosci 2:638, 1990.Google Scholar

Corssen, G, Domino, EF: Dissociative anesthesia: further pharmacologic studies and first clinical experience with the phencylcidine derivative CI-581. Anesth Analg 45:29, 1968.Google Scholar

Friedberg, BL: Hypnotic doses of propofol block ketamine induced hallucinations. Plast Reconstr Surg 91:196, 1993.Google Scholar

Court, MH, Duan, SX, Hesse, LM, et al.: Cytochrome P-450 2B6 is responsible for interindividual variability of propofol hydroxylation by human liver microsomes. Anesthesiol 94:110, 2001.Google Scholar

Guit, JBM, Koning, HM, Coster, ML, et al.: Ketamine as analgesic with propofol for total intravenous anesthetic (TIVA). Anaesthesia 46:24, 1991.Google Scholar

Oxorn, DC, Ferris, , Harrington, E: The effects of midazolam on propofol-induced anesthesia: propofol dose requirements, mood profiles and perioperative dreams. Anesth Analg 85:553, 1997.Google Scholar

Friedberg, BL, Sigl, JC: Bispectral (BIS) index monitoring decreases propofol usage in propofol-ketamine office based anesthesia. Anesth Analg 88:S54, 1999.Google Scholar

Man, D: Premedication with oral clonidine for facial rhytidectomy. Plast Reconstr Surg 94:214, 1994.Google Scholar

Baker, TM, Stuzin, JM, Baker, TJ, et al.: What's new in aesthetic surgery?Clin Plast Surg 23:16, 1996.Google Scholar

Goyagi, T, Tanaka, M, Nishikawa, T: Oral clonidine premedication reduces awakening concentrations of isoflurane. Anesth Analg 86:410, 1998.Google Scholar

Friedberg, BL, Sigl, JC: Clonidine premedication decreases propofol consumption during bispectral (BIS) index monitored propofol-ketamine technique for office based surgery. Dermatol Surg 26:848, 2000.Google Scholar

Friedberg, BL: Propofol-ketamine technique. Aesth Plast Surg 17:297, 1993.Google Scholar

Friedberg, BL: Minimally invasive anesthesia for minimally invasive surgery. Outpatient Surgery Magazine. Paoli, PA, Herrin Publishing Partners LP 2:57, 2004.

Friedberg, BL: Does LMA equal GA? (letter). Outpatient Surgery Magazine. Paoli, PA, Herrin Publishing Partners LP 6:15, 2003.

Friedberg, BL: Brain is target organ for anesthesia. Anesthesia Patient Safety Foundation Newsletter (www.apsf.org) 20(3), Fall 2005.Google Scholar

Kearse, , Rosow, C, Zaslavsky, A, et al.: Bispectral analysis of the electroencephalogram predicts conscious processing of information during propofol hypnosis and sedation. Anesthesiol 88:25, 1998.Google Scholar

Twersky, RS: Office-based anesthesia: Considerations for anesthesiologists in setting up and maintaining a safe office anesthesia environment. Park Ridge, IL, American Society of Anesthesiologists. 2000.