In response to https://www.washingtonpost.com/national/health-science/what-we-know-and-dont-know-about-memory-loss-after-surgery/2018/04/12/0b7e32da-3e32-11e8-955b-7d2e19b79966_story.html?noredirect=on&utm_term=.fa9859ba0747
As a 40-year practicing, board-certified anesthesiologist, I was an early adopter of the 1996 FDA approved BIS brain monitor to directly measure my patients’ brain response to propofol effects under anesthesia. Prior to 1996, only brain stem signs (heart rate & blood pressure changes) guided anesthesia dosing. Pain & the awareness of consciousness are processed at higher brain levels; i.e. the cerebral cortex.
In 2000, I published a statistically significant 30% reduction when using this monitor compared to relying on brain stem signs. (Friedberg BL: Dermatol Surg 2000;26:848.) Big Pharma has no financial interest in any reduction of anesthetic drug use. Dr. Cole is also the past president of the American Society of Anesthesiologists (ASA) that receives substantial financial support from Big Pharma. The ASA continues to resist recommending BIS monitoring for major surgery under anesthesia. A clear conflict of interest exists between patients’ getting the best available technology to avoid over medication and the financial underpinnings of the ASA.
There may be many reasons for POCD. However, it makes no sense to continue to over medicate patients by 30%, especially for patients over 50 like Dr. Cole’s father. (Friedberg BL: Br J Anaesth Sep 28, 2015;115:i114-i121)
The goal of my nonprofit Goldilocks Foundation is making brain monitoring a standard of care for major surgery under anesthesia. Patients will be better able to advocate for this monitor by downloading a free copy of ‘Getting Over Going Under, 5 things you MUST know before anesthesia’ from the foundation web site. No ‘donate’ or ’email’ buttons when downloading.
Disclaimer: Neither I, nor my nonprofit foundation receive BIS maker financial support.