Can friedberg’s triad solve persistent anesthesia problems? Over-medication, pain management, postoperative nausea and vomiting

 

Less is more. – Mies van Der Rohe

Without direct cortical measurement of anesthetic effect, neither reproducible science nor minimally tres- passing on patients’ physiology will occur. Predictably, problems like over and under-medication, postoperative pain management, and PONV will continue to plague anesthesiologists and their patients while incurring avoid- able costs.

Propofol measurement to 60 < BIS < 75 with baseline EMG provides amnesia and the perceived need of the com- monly used 2 mg midazolam premedication. Eliminating midazolam also may eliminate prolonged emergence in sensitive and/or elderly patients.

Direct cortical response measurement enables an- esthesiologists to treat patient requirements as the indi- viduals they are as opposed to the 80% of patients in the middle of the bell curve. Doing so eliminates outliers, transforms every patients’ “mystery” into an “open book test,” and creates the basis for more humane, cost-effective anesthesia care.