What Patients Should Know
Most Concerns About Anesthesia Side-Effects Are No Longer Necessary
There have been many blessings and benefits to patients since the introduction of anesthesia. However, until relatively recently, there have also been a number of risks that, today, are not necessary – if you know what to ask for.
The information about 21st century medical science I am sharing with you here is not only based on my 30+ years of administering anesthesia, but also on my own personal experience with my hip replacement. So I am speaking to you as both doctor and patient.
Too Much or Too Little…
In the past doctors have had to rely on monitoring your vital signs; heart rate, blood pressure, and breathing to determine how you were doing under anesthesia. Toward the end of the 20th century, it also became practical to measure blood oxygen levels. While very helpful, these signs did still did not directly indicate what was going on with the one organ the anesthetics medicate – your brain. As a result, your anesthesiologist could not be certain what level of consciousness you were experiencing.
Failing to directly measure your brain created two avoidable risks. One was that of administering too little anesthesia, which could result in you waking up during surgery but being unable to alert your anesthesiologist. The other was administering too much anesthesia, which could cause you to have delirium or even irreversible dementia after your anesthesia.
In the absence of reliable information on patient awareness, the standard, 20th century approach has been to over-anesthetize you to avoid discomfort and get you through the surgery. Then dealing with the after-effects it becomes someone else’s problem.
This is how all anesthesiologists are trained.
…Or Just the Right Amount
In 1997, I began using an additional monitoring device so I actually could be confident of how my patients were doing under anesthesia. The brain monitor allows me to directly observe exactly what degree of “sleep” my patient is experiencing. Based on that highly reproducible, reliable piece of information, along with monitoring vital signs and blood oxygen levels, I can know without question that I am keeping my patients comfortable and happy using only the amount of anesthetic necessary.
Using the brain monitor dramatically reduced the already miniscule risk of patients waking during surgery because I can literally see that the brain is “asleep.” And it virtually does away with post anesthetic dementia or even disorientation because my patients do not receive excessive anesthesia.
Eliminating Other Discomforts
One of the most common and unpleasant anesthesia after-effects is post operative nausea and vomiting (PONV). The anesthesia method I have developed, The Friedberg Method of Goldilocks Anesthesia (not too little, not too much, just the right amount), employs a combination of two highly effective non-narcotic anesthetics, propofol and ketamine. Each serves a slightly different purpose in assuring my patients are well “asleep” and pain free. Neither is likely to produce PONV. As a result, my patients go under easily and, yes, happily, waken quickly and enjoy being free of unpleasant anesthesia side effects after surgery.
So Why Isn’t Every Doctor Using This Method?
There are a few reasons why this method is not (yet!) being used universally. Without getting into the politics of anesthesia and their drug companies, let me simply say that change comes slowly in the medical field.
In addition, because The Friedberg Method uses about 30% less anesthesia, drug companies aren’t crazy about it. And because using brain monitors is not yet taught in anesthesia training programs, anesthesiologists are still stuck in the 20th century paradigm of giving anesthesia.
Even though brain monitors are available in 60% of major hospitals in the country, the disposable $20 sensor strip that is placed on the patient’s head is not currently billable to insurance companies. Can you believe it?! Patient comfort and safety are placed secondary by the medical establishment because they can’t collect from the insurance companies on it.
There’s Good News. And More Good News.
The good news is that the Friedberg Method of Goldilocks Anesthesia does exist and is backed up by years of reproducible experiences. If you, your surgeon, or your anesthesiologist would like to see the protocol for what I am describing, please go to http://drfriedberg.com/chapter-1.html.
The other good news is that you, the patient, can take simple steps to have your anesthesiologist apply the Friedberg Method of Goldilocks Anesthesia when you have surgery. The What Patients Must Do page will give you the details.
(Full disclosure: I am not affiliated with any drug companies or with the manufacturers of brain monitors. I gain absolutely no financial benefit when anesthesiologists use my method. My only motivation is upholding the oath I took which is, in part, “First, do no harm.”)