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Douglas R. Blake, Office-Based Anesthesia: Author's Response to Commentary, Aesthetic Surgery Journal, Volume 29, Issue 1, January 2009, Pages 79–80, https://doi.org/10.1016/j.asj.2008.11.009
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TO THE EDITOR
Dr. Halperin's commentary1 on my article2 (“Office-Based Anesthesia: Dispelling Common Myths,” published in the September/October 2008 issue of the Journal) expands the controversy surrounding anesthesia care for complex surgery in the office setting. The anesthesia technique used at the facility at which I practice developed out of the need to provide adequate anesthesia/sedation for complex, sometimes lengthy, cosmetic surgeries without resorting to conventional general anesthesia. Therefore, we excluded invasive airway devices, paralysis, and vapors or gases. The infusion of propofol-ketamine (PK) to produce deep sedation while maintaining spontaneous ventilation, simple devices to supplement oxygenation, and multiple intercostal nerve blocks (ICNB) to produce truncal anesthesia quickly demonstrated to anesthesiologists and surgeons that these modalities were able to provide anesthesia safely.
I was invited by Aesthetic Surgery Journal to submit an article specifically on the topic of PK in aesthetic surgery, which was felt to be of interest to the Journal's readership. The format for the article, focusing on “dispelling common myths,” was suggested by many discussions with colleagues in our large group practice at a major teaching hospital, 3 ambulatory service centers, and 2 operatories. The data presented represent the work of 10 years, including 4800 patients undergoing more than 5200 procedures performed in a single certified and licensed operatory by board-certified specialists with teaching appointments at the medical school of Brown University in Providence, RI. These data have been presented for continuing medical education credit at academic conferences sponsored by Brown University, Mount Sinai School of Medicine, and the New England Society for Plastic and Reconstructive Surgery. Dr. Halperin's comments about my article including: (1) “…anecdotal experience not tested by scientific principle”; (2) “the physician practitioner who practices medicine in isolation without peer review”; (3) “suboptimal clinical care”; and (4) “the desire by some individuals to abandon the principles of scientific thought and medical practice,” (stated twice) seem misdirected as a commentary on my article.
