of more than 60 but less than 75 with baseline, real-time EMG — elim-
inates ketamine hallucinations and dramatically reduces loss of air-
way and blood pressure drops during induction. There's no change in
SpO
2
tone during induction and spontaneous ventilation is preserved.
I'm now up to more than 6,000 patients, and none has ever been hos-
pitalized for post-op pain management, PONV or post-op cognitive dys-
function (brain fog). I practice office-based cosmetic surgery anesthe-
sia. And the "nifty fifty" works just as well to prevent post-op pain
when using regional anesthesia with propofol sedation as it does with
general inhalational anesthesia, especially when it's given without the
benefit of direct cortical response (brain) monitoring. A 14-minute
YouTube video detailing the "nifty fifty" is at osmag.net/MCwCo7.
I believe it's no longer acceptable to rely on the absence of heart rate
and blood pressure
changes to be sure
you're protecting the
patient's brain from
incoming noxious
pain signals that occur
with skin incision.
Heart rate and blood
pressure are brain
stem functions.
Consciousness and
pain are processed at
higher cortical levels.
In fact, the American
Society of
Anesthesiologists'
awareness study
M A R C H 2 0 1 7 • O U T PA T I E N TS U R G E R Y. N E T • 2 7
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