If you are interested in or have questions about anesthesia, whether you are a patient, the loved one of a patient, or a medical professional, you will find Dr. Friedberg’s insights interesting and useful.

We welcome your questions and invite you to submit them on the Contact Us Page.

Los Angeles, CA – Propofol/Ketamine for Moderate Sedation

Goldilocks Anesthesia Technique “Not too much, not too little, just right”

As an increasing number of procedures requiring sedation are done in the outpatient setting, Sedation Consulting is presenting this seminar to help physicians and nurses involved in sedation administration to minimize the risks associated with the anesthesia or analgesia being provided for procedural sedation.
This course is designed to introduce non-anesthesiologist providers to techniques to safely incorporate the use of hypnotic agents for procedural sedation for ambulatory surgery and office based practices. Increase patient satisfaction and margin of safety by decreasing the amount of sedatives required and by virtually eliminating post operative nausea and vomiting. Patients are at less risk when recovery time is significately decreased from hours to minutes.

*With the use of P/K anesthesia technique PONV (post operative nausea and vomiting) is decreased to less than 1% or 0.6% without the use of anti-emetics, 30% less anesthetic is required, outliers are eliminated, patient safety and satisfaction are dramatically improved.

Course Objectives

At completion of this course participants should be able to:
Dispel the myths and misinformation surrounding propofol administration by non-anesthesiologists
Oversee and delegate the sedation administration
Describe the standards and regulations as related to office based anesthesia and analgesia
Describe and utilize the necessary monitoring and emergency equipment required
Describe appropriate monitoring and documentation
Develop acceptable recovery & discharge protocols

Faculty

Dr. Barry Friedberg, a board certified anesthesiologist, recognized as a medical expert in anesthesia by the California Medical Board in addition to the legal profession. His expertise has been lent to a number of peer-reviewed medical journals for review. Dr. Friedberg is also a contributor to the letters to the editor section in several anesthesia and surgery journals. Dr. Friedberg is considered a pioneer in propofol/ketamine or PK anesthesia techniques

What Participants Are Saying:

“The practice of medicine requires a lifetime commitment to learning and flexibilty to provide the best care for our patients. Unfortunately, the practice of plastic surgery tends to be inflexible and focused on the use of general anesthesia which in my opinion is more for the surgeon’s convenience rather than the patient’s in many cases. As it has been my focus to perform natural aesthetic procedures which are safe, under local anesthesia with light sedation and with a quicker recovery, Dr. Friedberg’s contribution to my practice through his experience is truly appreciated.”

Amiya Prasad MD, Cosmetic Surgeon New York, NY

“Barry Friedberg, MD (Anesthesiologist) has masterfully developed the PK Anestheisa concept and he has honed this technique to perfection. Take his course!”

Robert A. Shumway, MD, FACS San Diego, CA

Physicians CME

This activity has been reviewed and is acceptable for up to 16.25 Prescribed Credits by the American Academy of Family Physicians, of these credits 7.50 hours conform to the AAFP criteria for evidence based CME clinical content. AAFP Prescribed Credit is accepted by the American Medical Association as equivalent to AMA PRA Category I Credit toward the AMA Physician’s Recognition Award. Non-members of the AAFP may claim up to 8.75 hours of AMA PRA Category I credit.

Nursing CE

We are an approved provider of continuing nursing education by The District of Columbia Board of Nursing, accredited for approvals by The American Nurses Credentialing Center’s Commission on Accreditation- ANCC

Location

Irvine Marriott
18000 Von Karman Avenue
Irvine, California 92612
(949) 553-01000

http://www.sedationconsulting.com/index.php?option=com_jevents&task=icalrepeat.detail&evid=95&Itemid=135


Will Michael Jackson’s killer, Conrad Murray, be sentenced to the maximum 4 year term?

Given Murray’s immediate remand to custody, it appears unlikely Judge Pastor will give him anything but the maximum 4 years. Anything less might provoke rioting among Jackson’s multitudinous fan base..

The only justice for the Jackson family will not come from Murray’s jail sentence but by Murray never again being able to practice medicine, at least in this country.

Murray’s native Grenada would most certainly welcome him back to practice there.

Sociopath that Murray is, he would just as likely resume practice without a license after his release.

It would be truly wonderful if Michael Jackson’s anesthesia over-medication death would serve as a wake-up call to American patients to be sure to demand a brain monitor when having surgery under anesthesia.

Without a brain monitor, anesthesia over-medication is a routine, sometimes lethal, practice.

Patients 50 & over (like Jackson & the rest of us baby boomers) are especially sensitive to the risks of anesthesia over-medication: delirium, dementia, & death.

“No surgery under anesthesia without a brain monitor” is the public education message of the non-profit Goldilocks Anesthesia Foundation.


Dementia after anesthesia (DAA) should be included in the types of dementia

When given without a brain monitor, anesthesia is always given in excess of what is thought necessary for fear of under-medicating (anesthesia awareness).

Goldilocks anesthesia is predicated on your individual brain response to anesthetic agents; therefore it is never too much, or too little, always just the right amount.

Patients older than 50 are especially sensitive to the negative effects of anesthesia over-medication: delirium, dementia & death.

Nearly one American surgery patient dies daily from anesthesia over-medication.

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

40% of patients discharged from hospital surgery come home with postoperative cognitive disorder (POCD) or ‘brain fog’ that can last as long as a full year.

Newman S et al: POCD after non-cardiac surgery: a systematic review. Anesthesiology 2007:106; 572

A certain number of patients never return to their pre-surgery mental function – dementia after anesthesia.

Once brain monitoring becomes the standard of 21st century anesthesia care, better numbers on this tragic, yet avoidable, outcome will become known.

Monk TG, et al: Predictors of Cognitive Dysfunction after Major Non-cardiac Surgery. Anesthesiology 2008;108:18

Disclaimer: Neither I nor my 501c3 non-profit Goldilocks Anesthesia Foundation receive financial support from brain monitor makers.

1996 FDA approved BIS brain monitors are found in 75% of US hospitals, yet shockingly only used 25% of the time.

If it were a matter of science to have convinced my anesthesia colleagues of the obvious (measure the organ anesthetics medicate – the patient’s brain!), then the 3500+ scientific papers over the past 15 years validating this self-evident concept would have turned the tide.

The obvious question is why does the American Society of Anesthesiologists (ASA) continue to trenchantly resist encouraging widespread use of this critical technology.

When something so obvious is not happening, one must follow the trail of dollars to understand.

1. The anesthesiologist (or nurse anesthetist) does not gain any fee increase for using the BIS monitor.

2. Since the hospital still does not have a billing code, it views every $20 disposable sensor as a loss.

3. The hospital does not have a billing code because the ASA has never supported the idea.

4. The implication of widespread brain monitoring is the 30% drop in drugs used to provide excellent anesthesia.

5. A 30% drop in drug sales would seriously hurt the drug companies who also give millions upon millions of dollars to the ASA in various forms of support.

6. The ASA could not continue to function without those millions of drug company dollars.

7. Therefore, for the ASA to encourage widespread use of the brain monitor would be to jeopardize their financial viability.

8. Organizations do not exist to threaten their ability to exist.

Prospective patients (& their loved ones) are the only people with a vested interest in the use of brain monitors.

Only patients (& their families) have to live with the long term effects of their short term anesthesia care.

The model for changing the anesthesia profession is the same one that got fathers in delivery rooms – public awareness leading to public demand.

For those who are inclined to help create public awareness, I have launched a petition on Change.org.

http://www.change.org/petitions/goldilocks-anesthesia-foundation-stop-the-epidemic-of-anesthesia-over-medication

I would very much appreciate your support.

The life or mind you save may be your own!

Download 3 free letters to save your life and mind from drbarryfriedberg.com

Check out the Amazon.com reviews of Getting Over Going Under, 5 things you MUST know before anesthesia.

All book proceeds support the pubic education message of the Goldilocks Anesthesia Foundation.

http://alzheimersweekly.com/content/10-types-dementia#comment-2360


Honorable mention in 11.08.11 Stereoboard.com by Jon Stickler

Conrad Murray Found Guilty In Trial – Fans & Advocates Release Post Verdict Reflection

While most of the media or independent commentators did not focus on these facts, there were exceptions. Beth Karas, Anthony McCartney, Linda Deutsch and the Associated Press, Law Med, Dr. Barry Friedberg, Sky’s Michael McParland, Michael C. Barnes, Dr Patrick Treacy, Matt Semino, Thomas Mesereau, and those of Michael’s friends who spoke up for him – voices that avoided easy soundbites and paid attention to the facts Michael Jackson’s toxicology and autopsy reports established.


Murray Guilty, Propofol Not!

More than 2 years after the avoidable death of Michael Jackson, a Los Angeles jury handed out the responsibility that Conrad Murray had denied.

When Judge Pastor asked for his plea, Conrad Murray blurted, “I am an innocent man.”

Murray’s defense sought to place blame everywhere aside from Murray’s shoulders, but the jury did not buy the claims.

“The general public has been needlessly traumatized over the safety of propofol” said anesthesiologist, Dr. Barry Friedberg. “I have said from the outset that propofol is safe, but Conrad Murray was not,”

The Michael Jackson chapter of ‘Getting Over Going Under’ concludes with ‘the only thing more reckless Murray could have done was take Jackson up in a plane and push him out without a chute.’

Prospective patients need not fear propofol but only need to assure that they will be watched and monitored, two things clearly absent in Murray’s negligent care.


Appreciation & notice of Change.org petition

Just a quick thank you to all who have accessed my web site from reading my blog. I am very touched by your attention. Please tell your friends! 🙂

Sad to report the passing of commentator & all around grumpy (but great) guy, Andy Rooney.

Since hospital records are pretty hard to access, I guess we will never know if Andy’s minor surgery was performed under general anesthesia &, if so, was there a brain monitor or not.

Based on the 25% usage of brain monitors in US hospitals, it is a statistical probability that Andy did not receive the benefit of a brain monitor &, hence, received too much anesthesia for his brain’s requirement.

Also, those who might be inclined are invited to sign my petition on change.org:

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

Thank you for your interest & continued support.

The mind you save could be your own!


Paid propofol expert, Paul White, prevaricates under oath… no such thing as ‘standard of practice’

When paid propofol expert, Paul White, testified in the Conrad Murray Michael Jackson manslaughter case, he tried to make a case for the ‘standard of practice’ being somehow different than the accepted ‘standard of care’ for sedation.

The only problem with his testimony is there is no such thing as the ‘standard of practice,’ and White knows it.

It is bad enough that White is facing 2 counts of contempt, but now, it appears he is trying to add perjury to his courtroom record.

Having given sedation for office-based surgery for nearly 2 decades, I can empathize with non-paid, propofol expert, Steven Shafer’s comment that ‘bedroom anesthesia’ has no tolerance for error because you have no backup.

In a surgeon’s office, it is not uncommon for only the surgeon, a non-RN scrub tech and myself to be giving elective cosmetic surgery care.

While, at least in accredited offices, there is oxygen, Ambu bag, suction, defibrillator & crash cart available, that ‘backup’ provides only a slight increment of patient safety.

More critical than the basic safety equipment is the ability to measure the organ medicated, the patient’s brain, in addition to the usual vital signs.

With direct brain measurement, one avoids over-medication, dramatically increasing patient safety by never taking the patient to deeper than intended sedation levels, thereby avoiding the need to rescue.

I can only speculate on what could have possibly motivated White to testify on Murray’s behalf but I am delighted with my decision to turn that offer down before White accepted it.

http://www.youtube.com/watch?v=7a8UdtoYgI8


ADA Walgren missed the point on Paul White cross exam

LA ADA David Walgren did a great job with Dr. Paul (cited 2X for contempt) White but missed the essential point:

Jackson could not have died from 25 mg propofol push in the 2 minutes Murray claimed to have been out of the room – just one of the multitude of lies Murray has spun to cover his a**.

Now the defense has suddenly suggested Jackson was already dead when Murray returned to the room. Duh.

Blown pupils are a sign of brain death which follows a minimum of 3-5 minutes without heart pumping activity.

Doesn’t really matter if breathing stoppage or abnormal heart rhythm (White’s ‘suggestion’) was the cause of the heart failing to pump oxygen carrying blood to the brain.

The lethal activity was leaving Jackson alone – reckless negligence, depraved indifference – guilty of involuntary manslaughter unless we’ve imported the Casey Anthony jury.

Stay tuned…

http://www.youtube.com/user/narkose3535#p/a/f/0/Es5suvGQOj4