Florida teen death: Anesthesia choice likely creates another avoidable tragedy in cosmetic surgery.

Corona del Mar, CA

She wasn’t as famous as Olivia Goldsmith, author of The First Wives Club, but Stephanie Kubela’s death was just as avoidable.

Complications from rare genetic disorder, malignant hyperthermia (MH), appear to be the cause of the Florida teenager’s needless death.

Triggering agents for MH are inhaled general anesthetic (GA) agents (i.e. halothane, desflurane and sevoflurane) and the muscle relaxant, succinycholine (SCH), used to intubate the airway.

GA is the predominant choice of anesthesia cosmetic surgery, so her surgeon was within the ‘standard of practice’ in that choice – expedience over outcomes.

Unfortunately, GA or the ‘standard of practice’ includes many unnecessary, avoidable and potentially fatal risks to patients choosing to have surgery that has no medical reason or indication.

Among those avoidable risks are MH, blood clots to the lungs, airway mishaps leading to lack of oxygen to the patient’s brain, postoperative nausea and vomiting (PONV), and postoperative cognitive disorder (POCD).

All of these risks can and should be avoided by having surgeons and patients choose a kinder, gentler anesthetic technique – propofol ketamine or minimally invasive anesthesia (MIA)® pioneered by Friedberg.

Neither propofol nor ketamine are triggering agents for MH. Had Ms. Kubela received MIA, she would likely be alive today. BIS monitoring of the patient’s brain gives a numerical value of propofol sedation at which ketamine can be given without negative side effects.

In 2005, The Doctors’ Company (TDC) Newsletter extolled the safety of propofol ketamine over general anesthesia for prevention of blood clots to the lungs. TDC is a medical malpractice carrier with a high percentage of plastic surgeons as insured.

No airway mishaps have been reported with MIA. With minimal trespass, patients tend to breathe normally and require little assistance or intervention to keep their airways open. No lack-of-oxygen accidents have been reported with MIA.

MIA has the lowest published rate of PONV, highly desirable, especially for facelift and tummy tuck patients.

Sometimes MIA is called ‘Goldilocks’ anesthesia. BIS monitoring eliminates the common anesthesia practice of giving too much for fear of giving too little. The opportunity for POCD is thereby greatly minimized.

More anesthesia providers are recognizing the advantages of MIA. Both surgeons and anesthesia providers need to be asked to provide it to optimize patient safety for cosmetic surgery.

Barry L. Friedberg, M.D. has been in active practice exclusively in office-based anesthesia for cosmetic surgery since 1992. He has published 30 letters to the editor, 14 articles and 6 book chapters including 3 in Anesthesia in Cosmetic Surgery recently published by Cambridge University Press.

More information can be found @ www.cosmeticsurgeryanesthesia.com , a patient oriented, non-commercial web site.

Disclaimer: Dr. Friedberg is not employed by Aspect Medical Systems, makers of the BIS monitor. He is not a stockholder or a paid consultant. The opinions expressed herein are his professional opinion based on 11 years experience with BIS monitoring.