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...

Watch BIS monitored propofol induction (aka Goldilocks anesthesia)