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Epidemic of Anesthesia Overdosing ... How Can You Avoid It?
Date:10/23/2007

CORONA DEL MAR, Calif., Oct. 23 /PRNewswire/ -- "Most patients tolerate their anesthetic experience despite the care they receive rather than because of it," claims Dr. Barry Friedberg, holder of the trademark "minimally invasive anesthesia (MIA)(R)." Anesthesiologists (and nurse anesthetists) have traditionally been taught to medicate patients on a per-kilogram of body weight to begin the patient's anesthesia. After the patient is asleep, subsequent medication doses are then adjusted primarily based upon changes in heart rate and blood pressure. However, the object of the anesthetic agents is to medicate the patient's BRAIN, not the heart rate and blood pressure. To ensure patients are actually asleep, the anesthesia provider was formerly obliged to over-medicate for fear of under-medicating. (N.B. "This common practice is informally known as the art of the controlled overdose," says Dr. Friedberg.) It is now possible to directly measure the brain's response to anesthetic agents.

(Photo: http://www.newscom.com/cgi-bin/prnh/20070803/FRIEDBERG )

Modern anesthetic agents are shorter acting, allowing patients to wake up faster. However, recent research points out the dangers of routinely giving excess anesthesia. At Duke, Monk showed higher one year postoperative death rates when patients were overmedicated as defined by bispectral index (BIS) values below 45 on a 0-100 scale. An inflammatory response to excessive anesthesia was suggested as the cause. At Emory, Sebel subsequently published a study confirming elevated levels of inflammatory markers (C-reactive protein) in patients that were overmedicated (BIS below 45) compared to those patients who were accurately medicated for general anesthesia (i.e. BIS 45-60).

It is not uncommon for relatives of elderly patients to observe that, in layman's terms, they are 'not quite the same' after their anesthesia as they
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SOURCE Dr. Barry L. Friedberg
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