showed that half of all patients who experienced awareness with
recall had no changes in heart rate or blood pressure that might have
alerted their anesthesia providers.
Unfortunately, until recently, heart rate and blood pressure changes
were the only information anesthesia providers had. Now that the FDA
has approved direct cortical brain monitoring, we can see that the
absence of facial EMG spikes during injection or incision, as shown by
direct cortical monitors, provides infinitely better information with
which to protect patients from pain.
It may be challenging for many anesthesia providers to accept this tech-
nique. Most will probably need to observe 10 to 20 cases to recognize and
believe in the dramatically improved outcomes. But I respectfully chal-
lenge Outpatient Surgery Magazine readers to try the "nifty fifty" and to
report what they observe.
Remember, just as it does no good to close the barn door after the
horses have escaped, it's futile to try to prevent post-op pain if you let
surgeons cut without first protecting the patient's brain from incom-
ing noxious pain signals that occur with skin incision.
OSM
Dr. Friedberg (drbarry@goldilocksfoundation.org) is the
president and founder of the non-profit Goldilocks Foundation
in Corona del Mar, Calif.
Anesthesia Alert
AA
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