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Overdose Awareness Device: BAMS’s Brain Activity Monitoring

April 9, 2009

I have lost track of how many times over the years my patients have told me that they took a long time to awaken from anesthesia after their past surgeries. They say they “got too much anesthesia”. Perhaps that is true, perhaps they have differing liver metabolism ability. Whatever the reason, currently there are devices available for monitoring brain activity BAM  i.e level of conscious/unconsciousness as a response to anesthesia medications. The devices are relatively cheap and easy to use. Personally,  I like them and use them but they are not available in every operating room.

This is one I use. BIS.

PK-MAC Minimally Invasive Anesthesia


An ideal anesthetic would have no need of an anesthesia
machine or anesthesia vaporizer. Propofol-ketamine monitored anesthesia
care (PK-MAC) is currently used in some offices and surgery centers by plastic
surgeons and the military. This technique of so-called “balanced anesthesia”
does not require the use of volatile anesthetic gas

Barry L. Friedberg, MDauthor of the book Anesthesia in Cosmetic Surgery and the article “Minimally
Invasive Anesthesia (MIA) for Minimally Invasive Surgery,” received a U.S.
congressional award for his development of the specialized PK-MAC trauma
technique used in the war zones of Afghanistan and Iraq. Currently, Dr
Friedberg lectures worldwide on the PK-MAC modality of anesthesia for
office-based cosmetic surgery.
This technique uses a combination of the intravenous medications
propofol and ketamine, and local anesthetics for anesthesia. No anesthesia
vaporizer is required, just basic vital signs monitors and a bispectral index
monitor (BIS) to monitor brain waves that correspond to depth of anesthesia.
The BIS monitor analyzes brain waves and compresses the encephalographic
representation to determine the level of consciousness or unconsciousness,
depicted by a number. The displayed numbers range from about 40 to 60,
depending on the brand of monitor, when the surgical plane of anesthesia
is reached. This monitoring technique is the key to knowing the depth of
anesthesia, which is a measure of the synergistic effects of the anesthesia
medications on the nervous system and EEG waves in particular. Once the
patient is rendered unconscious, the procedure continues with administration
of local anesthesia and more intravenous medications as required.

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