One has to admire Barry Freidberg, MD, for almost singlehandedly pushing for reform in anesthesia use and championing fundamental changes in how anesthesiologists conduct themselves, as well as promoting a one-man revolution for change in the kinds of tools in use by "gas passers." The anesthesiology sector hates him with a kind of quiet passion. However, with the passage of time and the proof mounting that the man makes a very GOOD point, many of these invaluable practitioners know, even secretly, that Friedberg is right on the money — the revolution, the tools, the conduct… it all has to change. Friedberg put forward many of his ideas in a recent article in PSP:
Currently, many anesthesia providers continue to work under the 20th-century concept of treating the brain response by overmedicating. They fear undermedicating patients. However, a safer approach to anesthesia for cosmetic procedures exists. It is new technology that has been scientifically validated and FDA-approved.
Millions of people undergo plastic surgery procedures every year. Some of those cases are restorative, due to accidental disfigurement, birth defects, or corrective secondary to a mastectomy or other operation that may have left them disproportional. The rest of these cases are purely cosmetic in nature.
[Freidberg] has an alternative to general anesthesia for elective cosmetic surgery. According to Friedberg, his approach offers plastic and cosmetic surgeons a safe, effective way to have these procedures in the office and without the need for the advanced airways, vasopressors, extra fluids, or high-dose opioids that leave patients groggy and hazy. He says his alternative reduces the risk of PONV to almost nothing.
Since the introduction of Dr Friedberg's "PK Technique" in 1992, and the addition of using brain activity monitoring (BAM) to that technique in 1997, the rate of PONV and the postoperative complications of blood clots and pulmonary embolisms has plummeted.
In addition, Friedberg introduced the use of the Dinamap in 1979, and pushed for it to improve patient safety before it was a standard of care. Friedberg's stated purpose was to give physicians the tools to improve safety. He has also founded the nonprofit Goldilocks Anesthesia Foundation.
Now, the journal Plastic & Reconstructive Surgery has published a piece on Friedberg's "Goldilocks anesthesia" methods. Friedberg, who frequently uses the "free PR' online news circuit to promote his position, published this news release recently:
Newport Beach, CA (PRWEB) April 6, 2010 — Goldilocks Anesthesia just published the secret to preventing both postoperative nausea and vomiting (PONV) and postoperative pain in the April 2010 issue of ‘Plastic and Reconstructive Surgery,’ the undisputed number one journal in the field.
“Goldilocks anesthesia prevents the patient from feeling pain during surgery and does not give any drugs causing PONV, like IV narcotics or stinky gases,” says Dr. Barry Friedberg, prominent, board certified anesthesiologist, founder and president of the non-profit Goldilocks Anesthesia Foundation.
No one over 50 should have general anesthesia without a brain monitor. Americans must make this a non-negotiable demand.
Goldilocks anesthesia relies on scientifically proven direct brain monitoring technology.
Without guidance by the patient’s brain response, 20th century anesthesia providers must routinely over medicate the patient short of causing death.
However, a recent publication points to one anesthesia death every day from anesthesia over medication.
“Death is not the worst outcome from excessive anesthesia,” says Friedberg. “Not waking up the same person the patient was before surgery is a far worse situation. Some call it ‘brain fog,’ others, dementia. Too many American families have seen loved ones suffer with this issue.”
Americans over the age of 50 are far more susceptible to the deleterious effects of routine anesthesia over-medication – postoperative cognitive disorder (POCD) as this dementia has been termed by the American Society of Anesthesiologists (ASA).
Without routine direct brain monitoring, anesthesiologists stuck in the 20th century mode of anesthesia instead rely on heart rate and blood pressure changes. This practice is now known to be notoriously inaccurate, resulting in more drugs being given for fear of giving too little.
“Standard of 21st century anesthesia care relies on patients’ individual brain response to guide drug dosing,” says Friedberg. “That’s why I call it ‘Goldilocks.’ Drug dosing is always just the right amount, not too much or too little.”
Too much alcohol is not good for the brain (see AA). Repeated head trauma is not good for the brain (see NFL).
“Why would any sane person believe that too much anesthesia would be good for the brain and without the potential for dementia?” asks Friedberg. “Why hasn't direct brain monitoring, like BIS, been widely promoted?”
First, no one, physicians in general (see Semmelweis, the ‘wash the hands’ pioneer of Vienna), especially anesthesiologists, readily change.
Second, without concomitant EMG trending, BIS has limited ability for proactive useful anesthetic management.
Third, the BIS maker is restricted by FDA approval from informing users of the increased utility of their device using EMG as the secondary trace.
Fourth, widespread brain monitoring could reduce anesthetic drug sales by as much as 30%, severely impacting Big Pharma's ability to provide millions of support dollars to the ASA.
For all these reasons, the non-profit Goldilocks Anesthesia Foundation was created to educate Americans to protect their brains if they need to ‘go under’ for surgery.
“No one over 50 should have general anesthesia without a brain monitor,” Friedberg says. “Americans must make this a non-negotiable demand.”
We admire Dr Friedberg's stance and commitment to patient safety, and cordially ask any physicians or anesthesiologists to comment on the ideas and practices outlined above.