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Preventing Negative-Pressure Pulmonary Edema in Healthy Cosmetic Surgery Patients
Scientific Forum
Letter to the Editor
Preventing Negative-Pressure Pulmonary Edema in Healthy Cosmetic Surgery Patients To the Editor: I am writing in reference to the article by Drs. Dieu and Upjohn and the Commentary by Dr. Matchett concerning “Negative-Pressure Pulmonary Edema in Healthy Cosmetic Surgery Patients” (2003;23;270-273). The cases described have in common the use of intubation and general anesthesia. Dr. Matchett said in his Commentary that the incidence of negative-pressure pulmonary edema (NPPE) is 1 or 2 per 2000 cases. These cases illustrate the advisability of treating healthy elective cosmetic surgery patients with Valium and ketamine dissociative anesthesia, which allows the reflexes to remain intact. All of the complications of narcotics, respiratory depressants, and intubation are thus eliminated.1-4 We have had more than 30,000 plastic surgery cases in our practice since 1966 without a single case of NPPE. According to the statistics cited above, we should have seen 30 to 60 such cases. In addition, a recent article has shown that administration of ketamine both decreases platelet adhesiveness and helps maintain muscle tone in the legs.5 These benefits are clear in our own practice: We encountered neither deep-vein thrombosis nor pulmonary embolism in any of our 30,000 cases. Drs. Charles A. Vinnik and Thomas Baker have informed me (personal communication: letter, May 2003) that they have never seen an instance of deep-vein thrombosis or pulmonary embolism in patients treated only with Valium and ketamine dissociative anesthesia in their own even more extensive series of cases. Our first obligation is the safety of the patient. Sedation with Valium and ketamine is so much safer than general anesthesia that this option should be considered for any elective surgery. Robert A. Ersek, MD Austin, TX
AESTHETIC
References 1. Vinnik CA. Intravenous dissociation technique for outpatient plastic surgery: tranquility in the office surgical facility, Plast Reconstr Surg 1981;67:799-805. 2. Baker TJ. Drug management in outpatient surgery, In: Surgical Rejuvenetion of the Face. St. Louis, MO: Mosby; 1986;15-35. 3. Ersek RA. A new sedation Magnetic Monitor board for medication monitoring during outpatient anesthesia. Lipoplasty Newsletter 1989;6:56-57. 4. Reinisch JF, Bresnick SD, Walker JWT, Rosso RF. Deep venous thrombosis and pulmonary embolus after face lift: a study of incidence and prophylaxis. Plast Reconstr Surg 2001;107:1570-1575. 5. Nakagawa T, Hirakata H, Sato M, et al. Ketamine suppresses platelet aggregation, possibly by suppressed inositol triphosphate formation. Anesthesiology 2002;96:1147-1152. 1090-820X/30.00 Copyright © 2004 by The American Society for Aesthetic Plastic Surgery, Inc. 10.1016/j.asj.2003.11.004
SURGERY
JOURNAL
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january/February
2004
49
Letter to the Editor
Preventing Negative-Pressure Pulmonary Edema in Healthy Cosmetic Surgery Patients To the Editor: I am writing in reference to the article by Drs. Dieu and Upjohn and the Commentary by Dr. Matchett concerning “Negative-Pressure Pulmonary Edema in Healthy Cosmetic Surgery Patients” (2003;23;270-273). The cases described have in common the use of intubation and general anesthesia. Dr. Matchett said in his Commentary that the incidence of negative-pressure pulmonary edema (NPPE) is 1 or 2 per 2000 cases. These cases illustrate the advisability of treating healthy elective cosmetic surgery patients with Valium and ketamine dissociative anesthesia, which allows the reflexes to remain intact. All of the complications of narcotics, respiratory depressants, and intubation are thus eliminated.1-4 We have had more than 30,000 plastic surgery cases in our practice since 1966 without a single case of NPPE. According to the statistics cited above, we should have seen 30 to 60 such cases. In addition, a recent article has shown that administration of ketamine both decreases platelet adhesiveness and helps maintain muscle tone in the legs.5 These benefits are clear in our own practice: We encountered neither deep-vein thrombosis nor pulmonary embolism in any of our 30,000 cases. Drs. Charles A. Vinnik and Thomas Baker have informed me (personal communication: letter, May 2003) that they have never seen an instance of deep-vein thrombosis or pulmonary embolism in patients treated only with Valium and ketamine dissociative anesthesia in their own even more extensive series of cases. Our first obligation is the safety of the patient. Sedation with Valium and ketamine is so much safer than general anesthesia that this option should be considered for any elective surgery. Robert A. Ersek, MD Austin, TX
AESTHETIC
References 1. Vinnik CA. Intravenous dissociation technique for outpatient plastic surgery: tranquility in the office surgical facility, Plast Reconstr Surg 1981;67:799-805. 2. Baker TJ. Drug management in outpatient surgery, In: Surgical Rejuvenetion of the Face. St. Louis, MO: Mosby; 1986;15-35. 3. Ersek RA. A new sedation Magnetic Monitor board for medication monitoring during outpatient anesthesia. Lipoplasty Newsletter 1989;6:56-57. 4. Reinisch JF, Bresnick SD, Walker JWT, Rosso RF. Deep venous thrombosis and pulmonary embolus after face lift: a study of incidence and prophylaxis. Plast Reconstr Surg 2001;107:1570-1575. 5. Nakagawa T, Hirakata H, Sato M, et al. Ketamine suppresses platelet aggregation, possibly by suppressed inositol triphosphate formation. Anesthesiology 2002;96:1147-1152. 1090-820X/30.00 Copyright © 2004 by The American Society for Aesthetic Plastic Surgery, Inc. 10.1016/j.asj.2003.11.004
SURGERY
JOURNAL
~
january/February
2004
49