Thunder from Down Under

Dear Dr Friedberg

Well, it was an interesting journey! I saw the surgeon today which is two weeks after my surgery. He says it’s healing well and the final result will be good. He also replied to my question that I was a good patient in the operating theater.

It did not start well a month ago. The anesthetist told me the operation would be under general anesthetic using gas. A BIS might be used with a target of 40 to 50, although many people thought the monitor is of little value. He was negative about ketamine. Although I was polite and mainly asked questions, at one point he said rather forcibly that I was trying to tell him how to do his job. Bit surly with no bedside manner. Not good!

To my surprise, he called me two days later. Said he had discussed what I asked for with colleagues and the surgeon, and was willing to use sedation with BIS, propofol and ketamine but there was a chance I might wake up during the procedure. He expressed interest in your 1999 ketamine–BIS–propofol paper, which I had mentioned, so I sent him a copy. When I next spoke with him the week before surgery he said he had read the paper and would try to follow it as closely as possible. The surgeon would use local anesthetic.

I don’t recall going under slowly – it just happened – but I woke up feeling fine. Surgery about 1-1/2 hours woke up inside 2 hours. Back home, did the newspaper crossword as usual that afternoon and ate normally. My wife has noticed no anesthesia after effects and my routine quickly returned to normal. Prior to the event, the nurse at the surgeon’s office said that I would be ‘pretty beat up in the week after surgery’ due to the anesthetic. This was not the case which I put down to use of sedation/ketamine instead of general anesthetic normally used here.

The anesthetist is with Australia’s leading anesthetic practice. I think this would have been a first, in Perth at any rate. It’s worked out well.

I am grateful and thank you for the information you sent, for the support you provided to me (a complete stranger), and for your interest in my case.

May I wish you a Merry Christmas (as we say here in Australia) and best wishes for the year ahead.


Bob S.

Perth, Australia