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.
Thieme has just published “Encyclopedia of Body Sculpting after Massive Weight Loss” edited by Drs. Berish Strauch & Charles Herman.
Chapter 5 is the only anesthesia chapter, Propofol/Ketamine Anesthesia, authored by yours truly, the champion of anesthesia patient safety.
read Getting Over Going Under by Barry L. Friedberg, MD
Author: Bob Etier
Published: November 17, 2010 at 9:19 am
Every day you brings you closer to the day when you will undergo surgery. It’s just a matter of odds—the longer you live, the higher the chances you will need surgical intervention of some type. Or maybe you need to have that bump on your nose straightened out, your breasts enlarged, or your face lifted. Whatever the procedure, you will need to be anesthetized (you know, knocked out). Barry L. Friedberg’s latest book, Getting Over Going Under reveals what you need to know to improve your surgical experience.
“Your surgery will be May 13, and your anesthesiologist will be Dr. So-and-So (of the Chicago So-and-So’s)…” your surgeon—or more likely his nurse or scheduler—says. Most of us leave it at that. We are so concerned about our surgery and its outcome, that we’re not thinking about our poor little brains and what could happen when we’re in drug-induce dreamland. Most patients are aware—or should be, since they signed that little piece of paper—of the risks of anesthesia. They include nausea, dizziness, hallucinations, brain damage, dementia, and death. However, Dr. Friedberg assures us that none of those things will happen if we take a more active part in choosing who will knock us out and how.
In Getting Over Going Under, Friedberg describes the “Goldilocks” method of anesthesia, in which the dosage is not done by guesswork but by using a brain monitor, a specific anesthetic drug (propofol), and something to fool your brain into thinking it’s not experiencing pain (ketamine). He also devotes a chapter to Michael Jackson and propofol, the drug that precipitated his death (the drug is vindicated; Jackson’s doctor is not).
Using the Friedberg method, following surgery the patient will wake up and be the person he or she was before anesthesia. Nausea and vomiting, intense pain, dizziness and other undesirable side effects do not occur. Also, patients will not wake up during surgery.
If Goldilocks anesthesia is so effective and safe, why don’t all hospitals and anesthesiologists offer it? In presenting his case, Friedberg examines reasons that this method is not embraced by all. I know you’re not going to believe this, but pharmaceutical company profits figure in.
Friedberg also explains patients’ rights and what a patient must do in order to get the anesthesia of his or her choice. Getting Over Going Under supplies the information patients need to improve the safety and success of their surgical experiences.
Read more: http://technorati.com/lifestyle/article/do-your-brain-a-favor-read/#ixzz15aLOnFpi
Check it out…
August 20, 2010 8:10:42 AM PDT
Dr. Friedberg,
I have been on your email list for a couple of years and am a new anesthesiologist practicing at a level 1 trauma center here in Utah. I understand the difficulty of trying to change the established medical dogma. I was wondering what evidence are you using to make the claim that lower BIS values (as a surrogate marker for “anesthesia overmedication”) or for that matter a change in anesthetic technique including regional or neuraxial anesthesia lead to differences in POCD and other peri-operative neuropsychiatric impairments?
Sincerely,
Jeff Macievic, MD
Mountain West Anesthesia
Salt Lake City, Utah
PS I routinely use a BIS monitor but was wondering what is the validity of the statements that you make to the lay public regarding anesthesia over medication. Thank you.
August 20, 2010 8:44:06 AM PDT
Jeff,
How about a 2 anecdote ‘evidence’ for you?
With 0.2 mg po clonidine premed 30-60 min. preop & BIS monitored propofol sedation, my average propofol infusion rates run 25-50 mcg/kg/min. – experience > 2500 cases.
Over a six week period in my practice last year, I took care of the following 2 pts., both had 6 hour procedures
62 y.o. Caucasian Female, 150 lb. otherwise fit, stated preoperatively, “Last last time I got propofol, I slept for 2 days.” Of course she was an anesthesiologist to boot!
I could barely keep her above BIS 60 @ 2.5 mcg/kg/min or one tenth of my low average propofol rate..
Turned off the propofol @ case end, she awakened immediately, said she didn’t hear, feel, or remember a thing!
Six weeks later, did a 58 y.o. Caucasian Male, 250 lb. Greenlander
It took 150 mcg/kg/min to keep him between 60-75 for the entire 6 hrs.
Turned off the propofol @ case end, he awakened immediately, said he didn’t hear, feel, or remember a thing!
Question, sir? How could I have not over medicated the first pt. and not under-medicated the 2nd pt. by sticking with my historically established ‘average’ propofol infusion rate?
Both pts. were discharged in less than 30 minutes.
I understand full well these anecdotal accounts are not ‘science’ nor do they purport to be.
I am only a clinician working in an office-based environment.
My pts. cannot have PONV or opioid requiring pain on emergence.
My pts. cannot sleep it off for a couple of hours in PACU.
I have nowhere to hide from my outcomes.
Hope this answers your questions.
I wish your pts. better outcomes!
Barry
http://www.michaeljackson.com/us/node/917514
Albeit in a non-surgical setting, nevertheless the LA coroner ruled that Michael Jackson died from a propofol anesthetic overdose.
The message of the newly published ‘Getting Over Going Under’ book is to educate the general public of the need to demand a brain monitor when going under anesthesia precisely to avoid anesthetic overmedication – a routine, yet nefarious 20th century practice prior to the introduction of a simple device to directly measure patient’s brain response to anesthetic drugs.
If convicted, Murray only faces a maximum of 4 years in addition to the loss of his medical license. The Jackson family rightly wants justice for Michael.
The real justice for the grieving Jackson family will be seeing his death not being in vain but helping tens of millions of Americans from being over medicated.
‘Surgery, anesthesia and your brain.’
Doesn’t have quite the same caché as ‘sex, drugs and rock ‘n roll.’
Most people will spend more time shopping their next car they than giving any thought to anesthesia for their upcoming surgery. They just assume someone is watching out for them.
What you don’t know about anesthesia could kill you, or worse, leave you in a bad state.
Estimates are that between 20-30 million people every year will have surgery and anesthesia. Ninety-nine point nine percent of them will be over medicated as a matter of routine anesthesia practice if they do not have a brain monitor as part of their anesthesia regimen.
The organization that claims to be watching out for patients under anesthesia is the American Society of Anesthesiologists (ASA). On March 9th this year, they publicly proclaimed themselves to be in ‘the never ending pursuit of patient safety and satisfaction…’
Those of you who may have followed my press releases on the wire or on my web site know that I debunked this myth in my March 11th press release as well as publicly challenging the ASA to defend their actions in delaying for 7 years (1983-1990) declaring pulse oximetry was a ‘standard of care’ in anesthesia as opposed to this specious claim in their press release.
Like Henry Ford II, they never explained and never complained.
When one cannot understand behavior, always follow the money. Turns out, anesthesiologists were billing for the use of the pulse oximeter until the ASA cut a deal with Medicare sometime in 1989 to bundle the extra charge into the basic anesthesia fee.
Once there was no longer any additional money to be made, the ASA declared the ability to know a patients’ oxygen status on a beat by beat basis fundamental to anesthesia safety; i.e. a ‘standard of care.’
Only recently did I learn the ugly truth about the billing issue and the standard of care declaration. This behavior on the part of organized anesthesia did not enhance the reputation of people like myself. I ‘went on the line’ to our hospital administrator in the name of patient safety reasons in 1983 and kept waiting for support from my national organization.
The Point: If you couldn’t trust the ASA in the 1980s on oxygen and patient safety, how can you trust them today with anesthesia over medication and brain activity monitors?
Using classic distraction tactics, the ASA has chosen to focus public attention on the 0.1% of Americans who might experience anesthesia awareness, while ignoring the public health risk to 99.9% of Americans routinely exposed to anesthesia over medication.
Americans, no one is looking out for you!
GoldilocksAnesthesiaFoundation.org was founded for this very purpose, to warm Americans of the insidious public health risk of routine Anesthesia over medication and the role of brain activity monitors in drastically reducing, if not outright eliminating, those risks.
To avoid over medication, patients need to ask their surgeon, facility administrator or person in charge of anesthesia if brain monitors are routinely used at the facility where surgery is scheduled. If the answer is not convincing, patients should go where brain monitors are routinely used.
When enough patient dollars are lost, institutions will reassess their practices. Brain
monitoring will become more commonplace and the public health risks of anesthesia over medication will dramatically diminish.
Disclaimer: Dr. Friedberg has no financial involvement with any maker of brain activity monitors.
I am looking forward to hearing from you…
Write soon and with passion.
Dr. Barry
This month’s Outpatient Surgery Magazine features a neat little article on how to prevent post-op delirium. http://www.outpatientsurgery.net/issues/2010/05/anesthesia-alert
Must have been written by an apologist for the American Society of Anesthesiologists.
Never once in the differential diagnosis of post-op delirium was the issue of anesthetic over medication considered and the possibility of radically mitigating (or even eliminating) post-op delirium by measuring the organ our anesthetics measure – the brain!
Also neglected in the author’s analysis was the that anesthesia over medication was responsible for nearly one death a day between 1999-2005. (Li G, Anesthesiol Apr. 2009)
What part of ‘medicate the brain – measure’ it escaped the author’s analysis?
Patients over 50, beware of anesthesia without a brain monitor!
The voice of Goldilocks Anesthesia Foundation (.org) has spoken.
