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Anesthesia Brain Monitor Another Perfect ‘Sleep’ Number

NEWPORT BEACH, Calif., Dec. 17, 2013 /PRNewswire/ — Best available technology to preserve postop brain function largely unused. Public needlessly traumatized about anesthesia awareness. Patients facing surgery MUST become proactive BEFORE surgery.

A recent NY Times article needlessly fanned public fears about exceedingly rare anesthesia under-medication with awareness and erroneously claimed “…consciousness isn’t something we can measure.”

“Under-medication is NOT the problem for the vast majority of patients receiving anesthesia, but over-medication most certainly is,” says Dr. Barry Friedberg, Board Certified Anesthesiologist.

The 1996 FDA approved BIS brain monitor is not to be confused with a nationally advertised mattress. However, Friedberg says a software switch transforms BIS into a critically useful device (i.e. BIS/EMG) that can help your anesthesiologist find your perfect ‘sleep’ number or, more accurately, the amount of anesthesia you need not to feel, hear or remember your surgery WITHOUT over-medicating you.

Without a brain monitor, the anesthesiologist is forced to use notoriously unreliable signs to guide dosing, resulting in routine over-medication.

Patients’ over age 50 brains are more sensitive to anesthetic drugs. Delirium, dementia, and death are the possible consequences of anesthesia over medication.

American Society of Anesthesiologists’ (ASA) members generate publications like those cited by this recent NY Times article. This ‘forest for the trees’ information only confuses the most important issue for patients facing surgery; i.e. avoiding routine over-medication.

The ASA appears unwilling to encourage its members to use the best available technology to preserve patients’ brain function after surgery. Why does the ASA appear to act contrary to the best interest of patients? Maybe because universal BIS/EMG monitoring could reduce anesthesia drug use by 30%, a potentially dramatic financial insult to Big Pharma that, in turn, provides millions of essential support dollars to the ASA, Friedberg suggests.

“The ASA ‘fox’ appears to be guarding the patients’ ‘hen house.’ Only greater public awareness of the avoidable risks by not having BIS/EMG monitoring for surgery can create the requisite force for change,” says Friedberg.

Published by the non-profit Goldilocks Anesthesia Foundation, ‘Getting Over Going Under’ was written in easy to understand language to help the general public with anesthesia fears and what MUST be done for surgery patients to become proactive.

“The bottom line,” says Dr. Friedberg, “Don’t let your parents, your spouse or anybody you love over 50 get anesthesia without a brain monitor or you may NEVER speak to that SAME person again.”

Contact Info:

Goldilocks Anesthesia Foundation
P.O. Box 10336 Newport Beach, CA 92658
949-233-8845

SOURCE Goldilocks Anesthesia Foundation

RELATED LINKS
http://drbarryfriedberg.com
http://www.nytimes.com/2013/12/15/magazine/what-anesthesia-can-teach-us-about-consciousness.html?_r=0
http://journals.lww.com/anesthesiology/Fulltext/2008/01000/Predictors_of_Cognitive_Dysfunction_after_Major.7.aspx
http://journals.lww.com/anesthesiology/Fulltext/2007/03000/Postoperative_Cognitive_Dysfunction_after.23.aspx
http://journals.lww.com/anesthesiology/Fulltext/2009/04000/Epidemiology_of_Anesthesia_related_Mortality_in.15.aspx


Low melatonin & POCD? Failure of NMDA block more likely

Certainly good to see this information: “The pain caused by a surgical incision may contribute to the risk of postoperative cognitive dysfunction.”

One effectively blocks incisional pain with complete NMDA receptor block; i.e. 50 mg ketamine 3-5 minutes pre-incision. Dose independent of adult body weight!

One protects the brain from negative ketamine side effects with a stable brain level of propofol easily achieved with an incremental induction (http://www.youtube.com/watch?v=GlQ3Do3b3_I) & made numerically reproducible measuring BIS <75 with baseline EMG. Using this paradigm over the past 16+ years & >3,500 patients has eliminated the need for postop opioids.

FWIW, eliminating opioids has resulted in the lowest published PONV rate (0.6%, cited in Apfel Millers PONV ch.) in a high risk group without the use of anti-emetics.


The Failure of Vision

The problem for most of my anesthesia colleagues (& their patients) is a failure of vision…

If you fail to measure the organ we medicate (i.e. the cerebral cortex), you are already doomed to over-medicate your patients.

If you fail to trend the electrical activity of the frontalis muscle or EMG as a secondary trace to the bispectral (BIS) index, you fail to have a useful, real time monitor.

If you fail to respond to EMG spikes as if they were heart rate or blood pressure changes, you fail to optimize the use of the BIS.

If you fail to prevent the signal of initial breach of the integument (i.e. skin incision or local anesthetic injection), all your anesthetic is doing is enabling your surgeon to inflict pain upon an unconscious patient whom you have rendered incapable of responding.

Over the past 15 years & >3,000 BIS/EMG propofol ketamine patients, none has required postop opioid (narcotic) treatment while posting the lowest postoperative nausea & vomiting (PONV) rate in a high risk group WITHOUT anti-emetic pretreatment.

If you insist on giving opioids +/or stinky gases, you continue to dare the patient to have PONV.

Most tragically, our colleagues have too often relegated my work to cosmetic surgery, not ‘real’ surgery.

Please consider listening to board certified, orthopedic anesthesiologist, Dr. Parson’s comments… http://www.youtube.com/watch?v=r6O-stIHlgo&list=TL8XOq1r9QY4Y

ALL surgery involves breaching the barrier between the world of danger & the protected world of self, aside from natural body orifice procedures.

Friedberg’s Triad: Measure the brain… preempt the pain… emetic drugs abstain.

Numerically reproducible outcomes for those professionals who choose to open their minds.


American Society of Anesthesiologists versus Dr. Barry Friedberg… Who is the greater fool?

Who is the greater fool?

One who thinks they are protecting their patients from pain but still must medicate with opioids post-operatively or one who found a numerically reproducible paradigm to eliminate the need for post-op opioids for 15 years?

Who is the greater fool?

One who has tried the cortical brain monitor & discarded it or one who has turned it into a real time, extremely useful monitor.

Who is the greater fool?

One who continues to give emetogenic anesthetics and ever more expensive anti-emetics or who has entirely stopped giving emetogenic drugs?

Who is the greater fool?

One who continues to do the same anesthetic, yet expecting different outcomes or one who has changed the paradigm, gotten numerically reproducible safer, simpler & more cost-effective outcomes & thought it would matter to his anesthesia colleagues?

If you build a better mousetrap, the world will beat a path to your door…& try to stab you to death for threatening change.

Friedberg’s Triad

1. Measure the brain (BIS/EMG…

Mathews DM, Clark L, Johansen J, et al. Increases in Electroencephalogram and Electromyogram Variability Are Associated with Increased Incidence of Intraoperative Somatic Response. Anes Analg 2012;114:759-770.

2. Preempt the pain (50 mg ketamine @ BIS <75 3 min pre-stimulation) Friedberg BL: Cosmetic surgery: Postoperative pain and PONV – dissociative anesthesia reconsidered. Plast Reconstr Surg 2010;125: 184e-185e. 3. Emetic drugs abstain (no opioids or smelly gases) Apfel C: Postoperative Nausea and Vomiting chapter in Miller’s Anesthesia, 7th ed. Philadelphia, PA, Elsevier 2010; p 2743. (2729-59). citing... Friedberg BL: Propofol-ketamine technique, dissociative anesthesia for office surgery: a five-year review of 1,264 cases. Aesth Plast Surg 23:70-74, 1999. NOT just for cosmetic surgery. Hear from an orthopedic anesthesiologist & part owner of Main Street Surgery center in Orange... http://www.youtube.com/watch?v=r6O-stIHlgo&list=UUJfRG14veFypW1wEqYYgSfA&index=3&feature=plcp

Watch BIS monitored propofol induction (aka Goldilocks anesthesia)
http://www.youtube.com/watch?v=GlQ3Do3b3_I&feature=plcp


Goldilocks Anesthesia Foundation reports success @ CSA Spring 2013 meeting

At the recent Spring 2013 meeting of the California Society of Anesthesiologists (CSA), held at the St. Regis hotel in Dana Point, the Goldilocks Anesthesia Foundation exhibited the ‘Work smarter, not harder poster; the book, ‘Getting Over Going Under’& the US Congressional award president & founder, Dr. Barry Friedberg, received for his propofol ketamine technique’s contribution to anesthesia safety for wounded troops in forward units.

Nearly 150 copies of ‘Getting Over Going Under’ were given out to attendees.

Many attendees were also given information about how to make the BIS brain monitor a real time, extremely useful, device.


Anesthesia awareness campaign persists

Anesthesia awareness is not lethal but anesthesia over medication, the natural consequence of failing to monitor depth of anesthesia, IS, specifically to the tune of one American patient every day!

Li G, et al: Epidemiology of Anesthesia-related Mortality in the United States, 1999–2005. Anesthesiology 2009;110:759

By trending EMG as a secondary trace, one creates a real time BIS monitor. Responding to spikes in EMG activity as if they were HR or BP changes is the key.

Mathews DM, Clark L, Johansen J, et al. Increases in Electroencephalogram and Electromyogram Variability Are Associated with Increased Incidence of Intraoperative Somatic Response. Anes Analg 2012;114:759-770.

Universal BIS/EMG monitoring would reduce anesthesia drug usage by 30% – a big hit to anesthesia drug makers who, in turn, provide millions of various forms of support dollars to organized anesthesia.

Friedberg BL, Sigl JC: Clonidine premedication decreases propofol consumption during bispectral (BIS) index monitored propofol-ketamine technique for office based surgery. Dermatol Surg 2000;26:848-852.

Every ‘anesthesia awareness’ article is a political statement by organized anesthesia:

“We are for patient safety…

ONLY as long as it doesn’t screw with the drug company money.”

Stop drinking the Kool Aid & stop the epidemic of anesthesia over medication…

http://www.change.org/petitions/prospective-surgery-patients-their-loved-ones-stop-the-epidemic-of-anesthesia-over-medication

Disclaimer: Neither I, nor my non-profit Goldilocks Anesthesia Foundation, receive financial support from brain monitor or drug makers.


Propofol & Michael Jackson’s death

We do not blame the automobile for the reckless drunk driver’s deaths. By his own public admission, Conrad Murray was reckless by giving Jackson propofol & leaving the room.

Hundreds of millions of patients worldwide have safely received propofol because someone was watching them breathe & monitoring their oxygenation.

Many medically licensed practitioners, nurses & physicians alike, have learned how to safely give propofol by taking this online course @ conscious sedation to learn how to combine direct brain measurement with pulse oximetry.

Conrad Murray was practicing as a cardiologist with hospital privileges to catheterize & stent diseased coronary arteries under propofol sedation & pulse oximetry. Despite this knowledge, he chose to buy the cheapest pulse oximeter monitor for Jackson – one that made no sounds & had no alarms.

Clearly, Murray does not believe the normal safety measures apply to his practice, behavior that defines him as a sociopath that never again deserves a license to practice medicine.


Surgeons’ Conundrum Exposes Patients to Avoidable Risks like Over Medication, PONV & Post-op Delirium

Virtually every cosmetic surgery begins with the injection of epinephrine in lidocaine solution.

Epinephrine provides shrinkage of the blood vessels (vasoconstriction) that minimizes blood loss during surgery.

Lidocaine can provide adequate pain relief (analgesia).

Since both drugs are given in the same syringe, having observed vasoconstriction, the surgeon ‘reasonably’ concludes the problem must be in the level of sedation when the patient moves during surgery.

Prior to the ability to directly measure the patients’ brain response to anesthesia, every patient movement necessitated more (& different) sedative treatment to insure no awareness or recall was responsible.

This practice led to excessive & erroneous medication of patients, leaving some with postoperative nausea & vomiting (PONV), pain or even post-op delirium.

With the advent of direct patient movement, the surgeon can make the differential diagnosis of more lidocaine or more propofol, leading to the more correct treatment.

Correctly treating the real cause of patient movement (inadequate local analgesia), avoids the need for excessive (or wrong) drugs, like narcotics, being given to patients & a far better postoperative outcome for all involved.

Direct brain monitored propofol sedation is the 21st century standard of care.

Be sure to ask if this will be done for your cosmetic procedure.