I think you will find these three “timed” photographs interesting. On the left our patient is still on the operating table. The operation finished about one minute prior, as the final dressings were placed. Note the time.
Only four minutes later, the patient is in the recovery room and is already responsive to questioning. When asked how she felt you can see the “thumbs up sign.” A little more than an hour and a quarter later the patient is alert, comfortable and ready to leave the surgery center for our specialized and exclusive postoperative recovery facility. Importantly, despite a history of nausea and vomiting after other surgery, the patient had neither.
What you are seeing here is modern cosmetic surgery anesthesia at its best. The credit always goes to the anesthesiologist. In this case, the patient had a very sophisticated and safe anesthetic technique known as “PK” anesthesia. The P stands for propofol which is the chemical name for Diprivan. It has been in the news a lot because of Michael Jackson. It is a fabulous drug, but as we learned from the Jackson experience, its place is in the hospital and outpatient surgery center – not the home. The K stands for ketamine. Ketamine is known as a dissociative drug. It puts the patient into a trance so that there is no awareness of one’s surroundings. It is not necessary to have the ketamine in force during the entire operation, only during certain key segments, such as the initial portion where the local anesthetic is being injected.
Incidentally, don’t forget that for nearly all cosmetic procedures, whether one is completely asleep or just heavily sedated, there is always going to be injection of local anesthesia because that is what provides freedom from pain. In addition, local anesthetic is combined with a drug, epinephrine or Adrenalin, which shrinks blood vessels to control bleeding and make the operation feasible and efficient.
One of the great benefits of the PK technique is a rapid emergence from the anesthetic and absence of post-operative nausea and vomiting. Incidentally, during the case there is no tube down the throat and not even an oxygen line going into the nostrils. The patient is sleeping and breathing air in the room, but with computer monitoring of pulse, blood pressure and oxygen.
One of the most prominent national proponents for this technique is the anesthesiologist for our patients, Barry Friedberg, MD (www.drfriedberg.com). Dr. Friedberg is the author of the only medical textbook exclusively devoted to anesthesia for cosmetic surgery entitled Anesthesia in Cosmetic Surgery.
I salute Dr. Friedberg and his technique. The patient’s smile says it all.