To the Editor
I read with disappointment your Spring 2000 Newsletter featuring Office-Based Anesthesia Safety as a Ôspecial issue.’ Had the ASA not recognized SOBA, the Society for Office-Based Anesthesia (www.soba.org), in its official guide for educational meetings, the absence of its mention would have been understandable. The only hint of its existence comes in reference 4 (Laurito, CE, President of SOBA) in Dr. Robert Morell’s front page article. I consider any reference to the Grazer/deJong Plastic & Reconstructive Surgery article on the danger of excessive blood lidocaine from tumescent liposuction (reference 8) nothing short of hysterical. The statistically biased sampling errors in this piece would not permit its publication in any anesthesia journal.
OBA is not new. Ralph Waters had the Downtown Clinic almost a century ago. OBA has resurfaced due to the economic pressures of our day. I have been engaged full time in OBA since March of 1992 and recently published an update of my seven-year, 1857 patient experience in the October 1999 & April 2000 SAMBA (Society for Ambulatory Anesthesia) Newsletters. My propofol -ketamine, opioid avoidance, room air, spontaneous ventilation (RASV) technique was specifically designed to maximize patient safety in the remote (office) setting. To date (> 8 years, > 2,100 patients), no hospital admissions have resulted for either PONV or pain, the two commonest causes of unexpected admission from day surgery. My outcomes are congruent with my belief system.
The most consistent error anesthesia practitioners continue to make in OBA is the routine use of opioid analgesics. Opioids not only contribute to the invariable persistence of PONV but also set the stage for unrecognized postoperative respiratory depression with the rare but totally avoidable patient demise. Please see my letter in the August 2000 issue of Anesthesiology, “Non-opioid analgesia improves outcomes.”
No one has a greater interest in patient safety than those of us engaged in the full time practice of OBA. Having no significant input from or reference to SOBA diminishes the credibility of your otherwise laudable effort.
Barry L. Friedberg, MD
Clinical Instructor in Anesthesia
University of Southern California