Liposuction ‘‘Conscious Sedation’’ Monitored Anesthesia Care and Level of Consciousness Monitoring Congratulations to Scarborough et al. [4] on their recent liposuction monitored anesthesia care publi- cation. Unfortunately, using the Ramsey sedation scaletotitratethedepthofpropofolsedationisusing 20th century technology when 2lst century technol- ogy [3] is readily available and more precise. The authors describe using a 1-mg/kg bolus of propofol, which is an appropriate induction dose for general anesthesia, while claiming to be performing ‘‘con- scious sedation.’’ Using a bispectral index level of consciousness monitoring, I routinely obtain moder- ate to deep sedation (depending on whether airway intervention is required (Table 1)) with propofol using multiple 150-lg/kg/20 s miniboluses and maintaining a 50- to 100-lg/kg/min infusion [1], as compared with the authors’ report of using 50- to 150-lg/kg/min for ‘‘conscious sedation.’’ Although the authors undoubtedly have enjoyed good success in their 15-year clinical experience, the path they outline is fraught with danger for those untrained in airway management. Inability to rescue from unintended deep levels of sedation/anesthesia is what may produce disaster instead of success. A re- centpublication[2]statesthatevenaregisterednurse directed by a surgeon may administer intravenous medications under the guise of patient safety! The money saved on anesthesia professional fees will be ‘‘pennywiseandpoundfoolish’’whenthecostsofthe inevitable medical liability claim is settled. Also, this report does not indicate the number of times the airway was lost, requiring a jaw thrust, nor does it mention of the incidence of postoperative nauseaandvomiting.Finally,Isincerelydoubtthata 6-mm liposuction cannula would meet many sur- geons’ definition of a ‘‘microcannula,’’ as the authors claim it to be. Barry L. Friedberg M.D. East Coast Highway, PMB 103 Corona del Mar CA, 92625, USA email: drfriedberg@doctorfriedberg.com Table 1. Continuum of sedation depth: definition of general anesthesia and levels of sedation/analgesia a Minimal sedation: ‘‘anxiolysis’’ Moderate sedation/analgesia: ‘‘conscious sedation’’ Deep sedation/analgesia General anesthesia Responsiveness Normal Purposeful b Purposeful b Response Response to verbal or tactile stimulation Response to verbal or painful Stimulation Unarousable, even with repeated painful stimulation Airway Unaffected No intervention required Intervention may be required Intervention often is required Spontaneous ventilation Unaffected Adequate May be inadequate Frequently inadequate Cardiovascular function Unaffected Usually maintained Usually maintained May be impaired a American Society of Anesthesiology, Standards, Guidelines, and Statements. b Reflex withdrawal from a painful stimulus is not considered a purposeful response. Aesth. Plast. Surg. 29:59–60, 2005 DOI: 10.1007/s00266-004-0035-3 Letter to the Editor