It's not going under the knife that is so dangerous during surgery. It's going under.

Risks of anesthesia include irreversible dementia if too much medication is administered. But if anesthesiologist Barry Friedberg has his way, those risks will be greatly reduced through the use of a simple technology that results in more accurate monitoring of consciousness and more precise dosing.

"Nobody should have general anesthesia without a brain monitor," said Dr. Friedberg. "Most people don't realize that if they don't ask specifically, the anesthesiologist is not going to use it."

The brain monitor is a simple medical device to track patient consciousness through the brain's electrical activity in the cerebral cortex.

"It is a simple idea, but nobody makes money using it. The hospitals have yet to find a billing code that the insurance companies will accept," Dr. Friedberg said. "And by using [a brain monitor with an EEG] you will use up to 30 percent fewer drugs and the drug companies are not going to be happy.... The only one who will benefit from use of this technology is the patient."

An Imprecise Science

Doctors don't really know how much anesthesia to give patients or their degree of consciousness during surgery. Both issues can be addressed through brain monitoring.

"We have a complicated calculus trying to figure out the best dosage of medications, but ultimately it's still a guess," Dr. Friedberg said noting criteria used to calculate doses such as age, weight, alcohol and drug use, even hair color.

The problem is that anesthesiologists must err on the side of giving too much medication. Most people recover just fine, perhaps after some short term grogginess or delirium.

"But we now know that anesthesia can also trigger an Alzheimer's-like dementia and that doesn't go away," he said. "And now you have tremendous social costs. It's tragic because when you damage the brain to the degree of creating dementia, there is no undoing it."

Dr. Friedberg, a private practitioner in Corona Del Mar, Calif., attributes the problem to routine over-medication. Too little medication is also a problem in anesthesia; we've all read horror stories of patients regaining consciousness and being unable to speak during surgery.

"They are two sides of the same coin: Failure to measure the organ that you are medicating, the brain. That is the problem," he said.

Dr. Friedberg started an organization to spread the word through patient education to encourage brain monitoring. The Goldilocks Anesthesia Foundation is so named because the goal is to get the medication doses just right.

"That's why I call it 'Goldilocks' because I can't give you too much or too little. It's always the right amount because it's your brain dictating to me what you need rather than me trying to guess," he said of the advantage of careful monitoring.

Dr. Friedberg also noted that traditional vital signs measures such as changes in heart rate and blood pressure are not an accurate measure of brain activity. He also said that many procedures, such as elective cosmetic surgeries involve local anesthetics that can allow lower general anesthetic doses.

Research is needed in this area to prove the effectiveness of brain monitoring but in the meantime, patients should ask if their anesthesiologist uses a brain monitor at the time the surgery is scheduled, and ask for a different anesthesiologist if the one assigned doesn't use the technology.

"It's a no-brainer," Dr. Friedberg said.

For more information, visit www.goldilocksanesthesiafoundation.org

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