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Biomedical subjects

B L Friedberg

Publications and source records attributed to B L Friedberg.

9 recordsLinked to original sources
PubMed2000

Clonidine premedication decreases propofol consumption during bispectral index (BIS) monitored propofol-ketamine technique for office-based surgery.

BACKGROUND: Propofol-ketamine anesthesia is a room air, spontaneous ventilation (RASV), dissociative intravenous (IV) sedation technique reported to have a near-zero postoperative nausea and vomiting (PONV) rate. Clonidine premedication has been reported to control blood pressure intra- and postoperatively, as well as to reduce the requirements for hypnotic agents. The bispectral index (BIS) monitor is a reproducible, objective, observer independent, quantitative measurement of the hypnotic state. OBJECTIVE: This study was designed to compare the propofol consumption rate during BIS monitored propofol-ketamine anesthesia for office-based, elective female facial rhytidectomy in patients with and without clonidine premedication. METHODS: Six patients receiving clonidine (200 microg oral premedication administered 30-60 minutes prior to induction of anesthesia were compared with a recent, historical control group of six patients who received no premedication. A BIS of 60-70 was chosen as the standard of comparison for light hypnotic state. A dilute propofol solution was used to gradually titrate anesthesia to a BIS of 60-70 prior to the administration of ketamine. RESULTS: A statistically significant reduction in propofol consumption was observed in the clonidine premedicated female elective rhytidectomy patients compared with those not receiving the clonidine. Other than modestly increased requirements for IV fluids, there were no adverse effects observed with clonidine premedication.

Administration, Oral↗
PubMed1999

The effect of a dissociative dose of ketamine on the bispectral index (BIS) during propofol hypnosis.

STUDY OBJECTIVE: To compare the effect of a standardized stimulus during propofol-only hypnosis on the bispectral index (BIS) value with the effect of the injection of local anesthesia for surgery during ketamine plus propofol hypnosis (dissociative monitored anesthesia care). To determine whether ketamine increases the level of propofol hypnosis when used in dissociative doses. DESIGN: Descriptive case study. SETTING: Private practice office plastic surgery suites. PATIENTS: 30 nonpremedicated ASA physical status I and II adult female (23) and male (7) patients scheduled for elective cosmetic surgery. INTERVENTIONS: Hypnosis was induced via slow (60 to 80 drops [gtts]/min), dilute (5 mg/ml) propofol solution. Hypnosis was induced using the BIS monitor as an adjunct to traditional vital signs and verbal contact. Patients were engaged in conversation and note was taken of the BIS value when verbal contact was lost and when BIS appeared to stabilize (BIS1). A standardized stimulus (0.3 ml 1% lidocaine plain via 30-gauge needle) was applied to the area of the supraorbital nerve. Note was taken of the highest BIS value (BIS2) in the patient response. The BIS returned to baseline hypnosis (BIS1) and a 50-mg dissociative dose (independent of body weight) of ketamine was administered. Two minutes were allowed to elapse and then the surgeon was allowed to inject the local anesthesia for the proposed surgery. Note was taken of the BIS value (BIS3) in response to the surgeon's injection. MEASUREMENTS AND MAIN RESULTS: The average delta (BIS2 - BIS1) was 9.5 + 6.9. Patients did not move in response to the surgeon's injection: BIS3 = BIS1. When movement occurred, the injection was terminated and additional ketamine was given before resuming the injection. Sixteen patients received ketamine 50 mg, 12 received ketamine 100 mg, one received ketamine 150 mg, and one received ketamine 200 mg. Men required an average 19% less propofol than women in this group. CONCLUSION: This study demonstrated a positive BIS response to a standardized local anesthetic stimulus during propofol-only hypnosis and a zero response during ketamine plus propofol hypnosis (dissociative anesthesia). Ketamine administered in dissociative doses does not deepen the level of propofol hypnosis. Hypnosis alone does not imply general anesthesia. Patients move in response to inadequate local anesthesia. Because the ketamine analgesia is only transitory and the primary analgesia is not given intravenously, propofol-ketamine technique is not a total intravenous anesthetic technique (TIVA). Instead, propofol-ketamine technique may be classified as a form of monitored anesthesia care (MAC).

Adult↗
PubMed1999

Facial laser resurfacing with the propofol-ketamine technique: room air, spontaneous ventilation (RASV) anesthesia.

BACKGROUND: Multiple anesthetic approaches exist for full-face laser resurfacing. The propofol-ketamine technique is reviewed as a reasonable alternative to providing adequate anesthesia for full-face laser resurfacing in the office environment. OBJECTIVE: To report outcomes using propofol-ketamine opioid avoidance, room air, spontaneous ventilation monitored anesthesia care (MAC). METHOD: A retrospective chart review of 95 consenting adult patients receiving propofol-ketamine anesthesia in a private practice, office-based setting. RESULTS: An average of 6 (200 mg) ampules of propofol, including waste, were used per patient. All patients received adequate anesthesia as evidence by a lack of movement during surgery. There were no hallucinations, no postoperative nausea or vomiting (PONV), no cardiovascular instability or seizures (clinical signs of lidocaine toxicity), and no hospital admissions for either PONV or pain. CONCLUSION: The propofol-ketamine technique appears to be an excellent alternative anesthetic approach to EMLA cream, tranquilizer-opioid regimens, or general inhalational anesthesia for facial laser resurfacing.

Adult↗
PubMed1993

Propofol-ketamine technique.

Case reports are presented demonstrating a new, safe, and simple intravenous technique for outpatient anesthesia. Vinnik's technique requires hypnotic doses of diazepam (Valium) to prevent ketamine-induced hallucinations. The initial hypothesis tested in this clinical series was whether hypnotic doses of propofol would prevent hallucinations from ketamine as satisfactorily as diazepam. Once the initial hypothesis was confirmed, consideration was given to moderating the cost of propofol by determining the effect of two levels of midazolam premedication on propofol requirements. Hypnotic doses of propofol do prevent ketamine-induced hallucinations. It is possible to achieve significant propofol savings by premedication with midazolam without compromising patient readiness for discharge by the end of the first postoperative hour.

Adolescent↗
PubMedDate not supplied

Propofol-ketamine technique: dissociative anesthesia for office surgery (a 5-year review of 1264 cases).

Propofol-ketamine technique is a room air, spontaneous ventilation (RASV), intravenous dissociative anesthetic technique which simulates the operating conditions of general anesthesia without the increased equipment requirements or costs. A total of 2059 procedures were performed on 1264 patients by 38 different surgeons. There were no hospital admissions for postoperative nausea and vomiting (PONV) or uncontrolled pain. All patients were pleased with their anesthetic and no hallucinations were reported. Cost:benefit analysis is presented as well as discussion of dissociative anesthesia being exempt from current California law (AB595).

Adult↗