Anesthesia Flix Fix: Episode Three

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Welcome to the third installment of Anesthesia Flix Fix, where I reflect on movies that I remember seeing in the distant past that had some kind of impact on me becoming an anesthesiologist.  And wow, I’m a little embarrassed to say that today’s movie is a really, really terrible movie, and yet I remember it being so entertaining the first time around.  In fact, I’m going to go out on a limb and say that it is one of Andy Garcia’s worst movies…even worse than When A Man Loves A Woman (I realize this movie got a 71% Fresh on RottenTomatoes but that’s gotta be because pre-plastic surgery Meg Ryan co-stars).  Michael Keaton fares a bit better as the crazy villain, but it’s basically the same whacked Beetlejuice and Pacific Heights (now THAT is a great movie) character that he is so adept at playing.

Can you guys guess the movie yet?  Remember, it’s got some pretty great anesthesia references in it…Anyone? Anyone?  Bueller???  Of course, just like rewarming pizza with a hair dryer and clothes iron, desperate times call for Desperate Measures!  And that’s our Anesthesia Flix Fix for today…with a whopping 17% Rotten rating.  Don’t worry…it’s still pretty entertaining despite the bad acting, weak protagonist character, and formulaic plot, especially as seen through our rose-colored anesthesia glasses.

I’ll set the scene up…Andy Garcia is an FBI agent who has a terminally ill son in need of a life-saving bone marrow transplant.  The one donor match that pops up on the computer is none other than the super-smart but bat-shit crazy, lock the door and throw away the key, super-bad prisoner villain played by Michael Keaton.  As an FBI agent, Andy Garcia gets Michael Keaton transferred to the operating room for a bone marrow harvest…but not before Keaton [somehow] acquires a vial of jailhouse Narcan, ties it to his tooth with some dental floss, and swallows the tethered anti-drug.  Pretty suspenseful and believable, eh?  Oh, just you wait!  Here’s the rest of the scene for your viewing pleasure:

Phew!  Wowza!  Right???  I’ll give you a moment to go pee and take your Xanax.  Now, that was Anesthesia in Hollywood at its best, don’t you think?  On the plus side…the anesthesia guy was Asian, and I’m all for that.  Diversity on the big screen…nice.  On the flipside, he’s a total dweeb…”Um…it’s not dropping…I don’t understand…he’s not responding to the anesthetic…Um”.  What is this…Beavis and Butt-Head do anesthesia day?  Maybe it’s because you only gave him 3cc of Demerol?  Please, please, please…I hope none of you sound like that as anesthesia professionals.  Be confident, be assertive, be anyone except that guy for Chrissakes!

And wow again…who ever would have thought that an anesthesia breathing circuit could be used as a flamethrower with such effect and pizzazz!  I will have to start hiding flint under my thumbnail and start practicing…maybe for the next critical events training in our operating room.  I’ll make sure the anesthesia tech puts one of those extra-long circuits on my machine that day.


Anesthetic Implications

In 1998 when this movie was produced, anesthesia was starting to experience a kind of resurgence after many years of lackluster jobs prospects as detailed by this eye-opening  and oft-quoted New York Times article.  But it was the heyday for technology in anesthesia, if you ask me.  As a resident in that time period, I remember using ultrasound for the first time, TEE, measuring endotracheal cuff pressures with fancy digital manometers, pupillometry for anesthetic depth and stimulation, epidural endoscopy, etc.  Not a day went by without someone bringing in a new toy for me to try out in the OR.

The brightest and most promising technology at the time was measuring the bispectral index…BIS monitoring.  This summation of the EEG purportedly would objectively quantify human consciousness and boil it down to a number, as surely as blood-pressure or heart rate could be measured, both saving anesthesia drug cost and preventing awareness under anesthesia.  After FDA clearance in 1997, BIS monitoring spread like wildfire, and the stockprice of Aspect Medical skyrocketed, as they sold the BIS monitor utilizing the proven razors and razorblades business model, giving away the monitoring hardware as long as anesthesiologists bought the disposable (and expensive) self-adhesive patient end of the monitor.  In one Time Magazine interview, BIS monitoring was proclaimed to be anesthesia’s Holy Grail.

 

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There is no way this anesthesia resident’s BIS is 97.  Either that or he is in a way too cushy program

But just like the BIS monitor that you see on Michael Keaton’s forehead in Desperate Measures (scroll to 08:30 in the clip), it wasn’t perfect and didn’t always ensure that patients were adequately unconscious (especially after only 3cc of Demerol).  It took about 10 years longer for the anesthesia community to figure out that BIS monitoring was indeed not up to snuff.  I wish I could find the photo I remember taking of about 15 BIS monitors my hospital had acquired…all piled up in their never opened, never used shipping boxes and headed to the dump.  By 2009, despite being used to measure the bispectral index of patients over 40 million times, Aspect Medical stock had plummeted and the company was sold off and out of the limelight to Covidien.  As would be written in The Atlantic on the topic of awareness under anesthesia:

“Today, the BIS monitor has become the most controversial medical device in anesthesiology, if not all of surgery.”

So perhaps this is a case where reality could have taken a cue from the imaginations of Hollywood.  No technology is infallible, especially when it comes to unlocking the mysteries of the human brain.  At one time, there was talk that governmental agencies (Medicare) and healthcare accreditation entities (JCAHO) would possibly soon require each and every patient undergoing general anesthesia to have documented BIS monitoring…it was that promising.  Now that will never come to pass.  And though there are still plenty of BIS monitors in use out there today, its relevance has been called into question.  Bispectral index will never be the be-all and end-all that it was meant to be.  Vigilance and the ability of the human brain to aggregate disparate information inputs are still the most effective and dependable way to ensure that our patients are safely and completely anesthetized.

Read: Anesthesia Flix Fix – Episode One

Read: Anesthesia Flix Fix – Episode Two

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