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aghast1 in print

Discussion in 'Anesthesiology' started by cchoukal, Jun 4, 2008.

  1. cchoukal

    cchoukal Senior Member Moderator 10+ Year Member

    Jul 10, 2001
    SF, CA
    Looks like aghast1 (aka barry friedberg) just had a letter to the editor published in A and A. I wonder if he'll put that in his CV...

    Avoiding Emetogenic Triggers in the First Place Is More Effective than Using Antiemetics
    Barry L. Friedberg, MD
    Anesthesia for Cosmetic Surgery; 3535 E. Coast Hwy., PMB 103; Corona del Mar, California; [email protected] or

    To the Editor:

    Congratulations to Gan et al. on their recent publication describing guidelines for the management and treatment of adults and children at risk for postoperative nausea and vomiting (PONV).1 Although regional anesthesia is mentioned as part of decreasing baseline PONV risk, the emphasis is heavily biased in favor of antiemetic therapy. The administration of adequate local analgesia may be the critical key to avoidance of emetogenic triggers and the subsequent PONV. Following this paradigm, a PONV rate of 0.5% in a high risk group of elective cosmetic surgery patients without the use of any antiemetics was published.2 Although this experience was lacking a control group, the results are consistent with other studies that included proper controls.3,4


    Gan TJ, Meyer TA, Apfel CC, Chung F, Davis PJ, Habib AS, Hooper VD, Kovac AL, Kranke P, Myles P, Philip BK, Samsa G, Sessler DI, Temo J, Tramèr MR, Vander Kolk C, Watcha M; Society for Ambulatory Anesthesia. Society for Ambulatory Anesthesia guidelines for the management of postoperative nausea and vomiting. Anesth Analg 2007;105:1615[Abstract/Free Full Text]
    Friedberg BL. Propofol-ketamine technique: dissociative anesthesia for office surgery: a five year review of 1264 cases. Aesthetic Plast Surg 1999;23:70[ISI][Medline]
    Song D, Greilich NB, White PF, Watcha MF, Tongier WK. Recovery profiles of outpatients undergoing unilateral inguinal herniorraphy: a comparison of three anesthetic techniques. Anesth Analg 1999; 88:S30
    Liu SS, Strodtbeck WM, Richman JM, Wu CL. A comparison of regional versus general anesthesia for ambulatory anesthesia: a meta-analysis of randomized controlled trials. Anesth Analg 2005;101:1634[Abstract/Free Full Text]
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  3. coprolalia

    coprolalia Bored Certified 2+ Year Member

    Aug 5, 2007
    I'm gonna go out on a limb here...

    aghast1 probably isn't even really needed in most of the procedures he participates in.

    We're apparently talking about minor cosmetic procedures using a ton of local. I'm beginning to think a sedation nurse could do what he does. A little midazolam, a little fentanyl, adequate amounts of appropriately placed lidocaine by the surgeon, and wham-bam thank-you-ma'am you're done and home that afternoon.

    That isn't really general anesthesia peformed by an anesthesiologist. Either that, or his level of care is not really necessary. Put another way, for the type of cases he's routinely doing it's probably like swatting a fly with a sledgehammer.

  4. swpm

    swpm Now with extra snarkiness 10+ Year Member

    May 15, 2006
    The guy's an ass of the first order, but I'm going to have to disagree with you here.

    His problem is his unsufferable ego, arrogance, and abrasive personality. While we mock him for trademarking an anesthetic technique that thousands of anesthesiologists used for many years before he "invented" it, the technique itself is certainly a good one in many circumstances.

    If his posts can be believed, his practice does include the full gamut of beautiful-people procedures, in which only local would be insufficient.

    Don't let your irritation with that knucklehead push your thinking from (appropriately) criticizing Pennsylvania plastic surgeons who "supervise" CRNAs to stating that all the California plastic surgeons really need are sedation nurses. :)
  5. coprolalia

    coprolalia Bored Certified 2+ Year Member

    Aug 5, 2007
    That was liposuction. Should've probably been done in the hospital. With the "Full Monty" anesthetic.


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