Author Topic: SAFETY AND SURGERY  (Read 3838 times)

Offline loiswstern

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SAFETY AND SURGERY
« on: October 16, 2012, 11:45:43 AM »
You already know the sad story of Michael Jackson and his death under questionable medical care. His attending physician, Dr. Conrad Murray, is now serving four years in prison for the involuntary manslaughter of his patient - who died in 2009 of acute Propofol intoxication. Noted anesthesiologist, Dr. Barry Friedberg was called to testify in this infamous case.

What I have learned from Dr. Friedberg is frightening, yet also gives us a clear call to action. Every day a vast majority of Americans are routinely over medicated when going under anesthesia simply because their anesthesiologists are not measuring their brains. During surgery, doctors routinely monitor the heart rate, blood pressure, oxygen levels in the blood, and administer an EKG; but ironically, it has not been routine to monitor the brain – the very organ that the sedation is working on. I am told that brain monitors are found in 75% of US hospitals, yet only used 25% of the time, mostly because patients simply do not know to ask for them.
Please listen carefully. Anesthesia over-medication is especially perilous for people over 50. Nearly 40% of people leave the hospital in a ‘brain fog,’ clinically called Post Operative Cognitive Dysfunction (POCD). One person dies daily from anesthesia over- medication. But death is not the worst result of the nefarious practice of routine anesthesia over-medication. The most serious risk faced from routine anesthesia over-medication is waking up with dementia after anesthesia (DAA) & never again being the same person as before they underwent anesthesia. This is a scenario that Dr. Friedberg firmly believes ould be eradicated with the use of a twenty dollar brain monitor sensor.

The FDA approved the BIS brain monitor 15 years ago. Yet the ASA has stubbornly resisted encouraging its widespread use. Americans should be outraged to learn the ASA appears more concerned with receiving millions of drug company dollars over preserving patients’ lives.
Anesthesia medicates the brain. BIS measures the brain’s response. Measuring is better than guessing.
A recent study conducted on 921 elderly patients undergoing major non-cardiac surgery confirms Dr. Friedberg’s assertions. To read details of the study, http://drfriedberg.com/in-the-news/bis-guided-anesthesia-decreases-postoperative-delirium-and-cognitive-decline.htmlclick here.

So what is the call to action for the rest of us? If you or a loved one needs surgery under anesthesia, ask the simple question: “Do you use a brain monitor when I will be under anesthesia? Demand BIS or go elsewhere for your surgery.
“Going under anesthesia without a brain monitor is like playing Russian roulette with your brain,” says Dr. Friedberg. “You have to live with the long term effects of your short term care.”
http://www.youtube.com/watch?v=Es5suvGQOj4Watch this brief interview with Dr. Friedberg.
« Last Edit: October 24, 2012, 01:59:47 PM by loiswstern »

Offline DrBermant

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Re: SAFETY AND SURGERY
« Reply #1 on: October 16, 2012, 06:57:46 PM »
You already know the sad story of Michael Jackson and his death under questionable medical care. His attending physician, Dr. Conrad Murray, is now serving four years in prison for the involuntary manslaughter of his patient - who died in 2009 of acute Propofol intoxication. Noted anesthesiologist, Dr. Barry Friedberg was called to testify in this infamous case.

What I have learned from Dr. Friedberg is frightening, yet also gives us a clear call to action. Every day a vast majority of Americans are routinely over medicated when going under anesthesia simply because their anesthesiologists are not measuring their brains. During surgery, doctors routinely monitor the heart rate, blood pressure, oxygen levels in the blood, and administer an EKG; but ironically, it has not been routine to monitor the brain – the very organ that the sedation is working on. I am told that brain monitors are found in 75% of US hospitals, yet only used 25% of the time, mostly because patients simply do not know to ask for them.
Please listen carefully. Anesthesia over-medication is especially perilous for people over 50. Nearly 40% of people leave the hospital in a ‘brain fog,’ clinically called Post Operative Cognitive Dysfunction (POCD). One person dies daily from anesthesia over- medication. But death is not the worst result of the nefarious practice of routine anesthesia over-medication. The most serious risk faced from routine anesthesia over-medication is waking up with dementia after anesthesia (DAA) & never again being the same person as before they underwent anesthesia. This is a scenario that Dr. Friedberg firmly believes ould be eradicated with the use of a twenty dollar brain monitor sensor.

The FDA approved the BIS brain monitor 15 years ago. Yet the ASA has stubbornly resisted encouraging its widespread use. Americans should be outraged to learn the ASA appears more concerned with receiving millions of drug company dollars over preserving patients’ lives.
Anesthesia medicates the brain. BIS measures the brain’s response. Measuring is better than guessing.
A recent study conducted on 921 elderly patients undergoing major non-cardiac surgery confirms Dr. Friedberg’s assertions. To read details of the study, http://drfriedberg.com/in-the-news/bis-guided-anesthesia-decreases-postoperative-delirium-and-cognitive-decline.htmlclick here.

So what is the call to action for the rest of us? If you or a loved one needs surgery under anesthesia, ask the simple question: “Do you use a brain monitor when I will be under anesthesia? Demand BIS or go elsewhere for your surgery.
“Going under anesthesia without a brain monitor is like playing Russian roulette with your brain,” says Dr. Friedberg. “You have to live with the long term effects of your short term care.”
http://www.youtube.com/watch?v=Es5suvGQOj4Watch this brief interview with Dr. Friedberg.

This should not be construed as medical advice. I am a retired Board Certified Plastic Surgeon.

Thank you for your post. I was able to fix your link compare to:

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To read details of the study, click here.

The image you tried to place is sitting on your computer and viewers on the internet need to see an image that can be linked to something they can also see themselves.



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Yes safety during surgery is critical. However, it is not just a brain monitor that is key to the disasters seen. Actually "magical" devices sometimes give a false sense of support or help for someone who should not be performing the procedure. Just because the number is right does not make the patient right either. I do not always like what the FDA does, but in this case I agree. Plastic Surgery Anesthesia is an art form. Safety comes from ensuring competent people continue to monitor what is going on. I fought many battles during my career to try to protect patients and limit their exposure to staff I did not feel were adequate for this art. Critical components like patient's oxygen levels were always a multiple person task and relied on many tools beyond just a pulse oximeter tone.

I preferred to use comfort during surgery is a critical component of a good experience, something I have championed over my career. Instead of depending on a central agent to depress the brain, I preferred to deal with a bigger picture. It is the deeper sleep the central agent is taking the patient, the higher the risks of the brain not getting blood supply.  Depending on central nerve poisons to control pain sometimes is the only way to go as when I was dealing with major Crainio Facial Fractures. Having such brain monitoring then, I am all for that. But those days were well before Propofol anesthesia. You cannot use local when piecing back together someone's skull or operating on the brain itself. The problem is, stop the anesthetic, ie wake the patient up, and the pain experience starts. I could work on minimizing the swelling such as my use of Swiss Therapy Gel Masks which I started with on the Facial Fractures, then went used them for Blepharoplasty, Rhinoplasty and Facelift Surgery Swelling.

The eyelid patients were done under local when for cosmetic, General when used for access to facial fractures. Facial fracture surgery patients were made so much more comfortable when the art evolved away from wiring the bones to rigid fixation with scews and plates. But the anesthesia factor went beyond. When using local to deal with the comfort, patient experience overall was just that much better as I monitored patient comfort. That led me to try to convert my Rhinoplasty to one of more local anesthesia instead of depending on the general for pain management. Monster improvement in patient comfort. If the patient waking up at the end of surgery, there was something there still preventing pain, or pain cycle was not permitted to start, patients used so much less medication, looked better (less swelling) and returned to activity faster. So I worked on and improved my local anesthesia for my facial patients.

Parallel to the facial finding, my Liposuction cases under local with sedation were just so much more comfortable than our General anesthesia patients. That is how my Tumescent Tummy Tuck all drifted away from General to the load managed by the block, not the Central Nervous System drugs. Monitoring was constant and moltimodal and our results documented. From blood color, to corneal response, to actually listening to the conversation my team was having with my patient as I was building the new belly button, fully comfortable and for some actually watching me operate. That level of monitoring beats numbers that sometimes were not adding up to what was being seen clinically. So toy equipped certification might be fine, if it went with so many other important parameters. But such game playing by manufacturers sometimes tries to claim just because someone is using it they can do well. "Because This Doctor Used Our SuperDuper Device They Pass." I prefer such decisions be managed by organizations for credentialing like we subscribed to for our Acredited Surgery Center, and that device was not on the list and failed when I was assessing it to warrant adding.

I had a long history of interests i brain monitoring having built my own EEG electrodes and electrical safety halter to convert our Physics Department Tektronix Oscilloscopes to EEG devices when I was a college student. I Incorporated such games to make the mandatory Physics course something palatable to the other Pre Med majors having to take it. I also came up with a pulse oximeter primitive version from the Mercury Astronauts Hewlett Packard bulky earpiece. Mine was just a LED and Photo transistor. I guess I would have been in a different situation now if I had patented that back then. No I did not convert it to an actual PO2 number, but I had a great pulse wave on my finger watching my own heart EKG, brain EEG awake back in somewhere back in 1968 to 72. The computers back then had punch card confetti and the new Wang calculators supplemented our KE bamboo slide rules. Yes, times have changed.

I liked the direction we moved our anesthesia to the comfortable as much awake as patient wanted but not remembering experiences that permitted a lighter degree of the big central agents. The payback beyond safety, was someone waking up not entering a the pain cycle, earlier moving, comfortable, and less swelling and bruising. Compared to the painful deep general paralyzed tummy tucks I saw during training and on tape after tape course after course, this was a major advancement. I liked gadgets, that one was just not enough when we would periodically review if there were any changes in what it offered.

Hope this helps,

Michael Bermant, MD
Retired Plastic Surgeon
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Michael Bermant, MD
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