21st century anesthesia standard of care comes to Newport Beach, CA

Just heard from my pal who’s brother is being operated upon this April 2011 at Hoag Hospital in Newport Beach.

When the nurse came from the OR to talk to my pal, she told him all the anesthesiologists are using the BIS monitor on every case!

HALLELUJAH!!! Finally, the 21st century standard of care is being employed.

Maybe my efforts have finally paid off or maybe it was this tidbit:

In the April 11, 2011 issue of “Current Opinion in Anesthesiology,” they conclude: “Given the trivial cost of the BIS (brain monitor) and the proven benefits demonstrated in prospective randomized studies, we consider its use justified in every general anesthetic.”

As the Orange County anesthesiologist who first routinely used the BIS in December 1997, I am pleased for all patients, especially me should I be so unfortunate to be taken in for emergency surgery.

I would imagine their recovery room activities, along with the hospital’s bottom line, have been improved.

Now if they would only give the nifty fifty – 50 mg ketamine 3 minutes prior to incision, they could also dramatically improve postop analgesia.

Friedberg’s Triad

I. Measure the brain…no BIS lower than 45 with General Anesthesia

Hint #1: trend EMG as secondary trace

Hint #2: respond to EMG spikes as if they were heart rate or blood pressure changes

II. Preempt the pain…the ‘nifty 50’ – adult patients rx 50 mg ketamine 3 min prior to stimulation

Hint #3: Number of adult NMDA receptors independent of body wt

III. Emetic drugs abstain…no narcotics (opioids) or stinky gases (iso-, des- or sevo-flurane)

Hint #4: stinky gases are also oxidizing agents

Hint #5: BIS/EMG monitored propofol ketamine not just for cosmetic surgery

Here is orthopedic anesthesia specialist, Dr. Parson’s one-take, unrehearsed testimonial: