Anesthesia & Analgesia
1998; 86:1334-9

Dissociative Monitored Anesthesia Care
Not Cited

To the Editor:

The article by Sá Rêgo et al. (1) mentions ketamine but not dissociative anesthesia. In my opinion, they should have included the following references (2-7) with the other 172 cited in the article. Dissociative anesthesia is deep sedation with the intensification of laryngeal or "life-preserving reflexes" and is exempted in AB595, the current California law regulating office anesthesia (Sacramento bureaucrat responsible for administering AB595, personal communication, 1996). Dissociative anesthesia has been used in office plastic surgery for more than two decades.

As to midazolam premedication preceding propofol infusion, Oxorn et al.'s recent article (8) shows no significant reduction in propofol requirements for either induction or maintenance by adding midazolam premedication. Finally, to the issue of cost consideration, the use of room air and spontaneous ventilation with dissociative anesthesia obviates the need for an anesthesia machine. The capital acquisition as well as the maintenance costs of the anesthesia machine are eliminated. Eliminating inhaled anesthetics also eliminated a malignant hypothermia trigger, thereby eliminating the cost of stocking dantrolene.

Barry L Friedberg, MD
Society for Office Anesthesiologists
Newport Beach Ca 92663-1225

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References:

1. Sá Rêgo MM, Watcha MF, White PF; The changing role of monitored anesthesia care in the ambulatory setting. Anesth Analg 1997;85:1020-36
2. Pender JW; Dissociative anesthesia, JAMA 197,215:1126
3. Vinnick CA; An intravenous dissociative technique for outpatient plastic surgery: Tranquility in the office surgical facility. Plast Reconstr Surg 1981;67:799-805
4. Vinnick CA; Dissociative anesthesia in ambulatory plastic surgery: a ten year experience. Anesth Plast Surg 1985;9:225-25
5. Guit JBM; Ketamine as analgesic to total intravenous anesthesia with propofol. Anesthesia 1991;46:24-7
6. Friedberg BL; Hypnotic doses of propofol block ketamine induced hallucinations. Plast Reconstr Surg 1993;91:196-7
7. Friedberg BL; Propofol-detamine technique. Anesth Plast Surg 1993;17:297-300
8. Oxorn DE, Ferris LE, Harrington E, Orser BA; The effects of midazolam on propofol-induced anesthesia propofol dose requirements, mood profiles and periopeartive dreams; Anesth Analg 1997;85:553-9

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