Sir:
Congratulations to Bitar et al. 1 on the publication of their recent article. While I was honored to be among the cited references 2 on office-based anesthesia, I was, nevertheless, quite dismayed by several egregious omissions in the article.
First and foremost was the lack of an institutional review board approval for this retrospective chart review. Second, while this is most clearly an anesthesia article, the nurse administering the anesthesia was conspicuously absent from the authors’ article. Curious minds must wonder why.
Third, while a bispectral index monitor was described as being among the monitors used, no mention of the levels of bispectral index sedation was made in either the Results or Discussion section. Why? Fourth, despite a typical postoperative nausea and vomiting rate of 15 to 40 percent cited in the literature and the routine use of emetogenic fentanyl in all cases, Bitar et al. reported a 0.5 percent rate without any antiemetic treatment such as droperidol, ondansetron, or dexamethasone. To say this report strains the limits of credibility is an understatement in the extreme.
Fifth, 99.9 percent of the cases reported on were either American Society of Anesthesiologists class I or II. Healthy patients tend to do well despite the therapeutic regimen rather than because of it. Sixth, despite reporting the use of ketamine in some of their patients, there is no indication of any incidence of negative psychotropic experiences in these patients. Had they reported titrating the propofol to a bispectral index of 60 to 70 for the cases, 3 one would have had no issue with the failure to report on such outcomes.
Barry L. Friedberg, M.D.
REFERENCES
1. Bitar, G., Mullis, W., Jacobs, W., et al. Safety and efficacy of office-based surgery with monitored anesthesia care/sedation in 4778 consecutive plastic surgery procedures. Plast. Reconstr. Surg. 3: 150, 2003.
2. Friedberg, B. L. Propofol-ketamine technique: Dissociative anesthesia for office surgery: A 5-year review of 1264 cases. Aesthetic Plast. Surg. 23: 70, 1999.
3. Friedberg, B. L., and Sigl, J. C. Clonidine premedication decreases propofol consumption during bispectral (BIS) index monitored propofol-ketamine technique for office-based surgery. Dermatol. Surg. 26: 848, 2000.
