Study: More risk in office surgeries -- Disasters and Accidents...

I agree with Drs. Lubarsky & Brandom. Inhalational anesthesia is inappropriate for the office setting, especially for elective cosmetic surgery - surgery that happens without a medical reason. There are no avoidable anesthesia risks acceptable in this patient population. A since safer alternative has existed for more than a decade.

For the past 11 years, I have been measuring patients' brains' response to propofol (Diprivan®), an intravenous drug that replaced the old standby Pentothal®.

A brain activity monitor like the BIS® permits the anesthesiologist to precisely control the level of sleep using a number from 0-100. The lower the number, the more asleep the patient. 78-85 BIS facilitates conscious sedation. 70-78 BIS moderate sedation. 60-70 deep sedation. 45-60 general aensthesia when combined with systemic pain relief. Less than 45 BIS is considered excessive and may contribute to POCD (postoperative cognitive dysfunction and increased one-year death rates).

At the dentist's office, the injection of the local anesthesia hurts before the tooth goes numb. Adding ketamine at BIS less than 75, eliminates the hurt when the local is injected.

Neither propofol nor ketamine is a triggering agent for malignant hyperthermia.

The combination of BIS, propofol and ketamine is known as minimally invasive anesthesia (MIA)® or sometimes called 'Goldilocks' anesthesia. Interested readers can find more information @ www.cosmeticsurgeryanesthesia.com , a non-commercial patientoriented web site.

While the mixture of propofol and ketamine is a great combination, it was used far earlier than the date of your "copyright". Thus it is not unique to you as anesthesia providers have been using that mixture for many, many years.

Oh please, Barry. You are so self-promoting with your "technique", which was used years before with Brevital and Ketamine drip.

Also, you are totally wrong about the safety of inhalation agents in office surgery and you know it. Show me some facts and evidence that inhalation anesthesia is not safe...you won't be able to, because they are not there, because it IS safe.

There are many ways to do safe anesthesia that have been studied and published in peer reviewed journals. Your self-promotion takes away from a good (but not the only) technique of anesthesia.