aghast1 in print

[cchoukal]

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 www.cosmeticsurgeryanesthesia.com

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

REFERENCES


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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[coprolalia]

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.

-copro

 

[swpm]

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.

-copro

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.

 

[coprolalia]

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.

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

-copro