Kanye West's mom's death d/t anesthesia?

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cchoukal

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As soon as I heard someone famous died having "routine plastic surgery," I started wondering when it would come down to the anesthesia. Didn't take long:

http://www.foxnews.com/story/0,2933,312369,00.html

http://www.medicalnewstoday.com/articles/88944.php

Anyone know who this guy in the 2nd story is? Other than a schill for Aspect? The guy is listing "letters to the editor" on his CV. Impressive.
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Yeah, I was thinking the same thing but the reputable newspapers have not had too many details.

"Minimally invasive anesthesia"? WTF?
 
Yeah, I don't think this guy sounds too credible. At the same time, I don't doubt that her death was truly from an anesthetic complication. I mean, aside from going through the chest wall through the LV or aorta during a boob job, it seems pretty hard to kill someone from the cosmetic surgery itself.
 
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I have lost ALL respect for Friedberg when i read this in the second article:

According to Aspect Medical Systems, makers of the BIS monitor, the sleep portion of general anesthesia ideally occurs at 45-60 on a scale of 0-100. "Minimally invasive anesthesia (MIA)® (BIS = 60-75) gives patients what they desire from general anesthesia with the lesser trespass of sedation," asserts Friedberg.
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Apparently that was very important to slip in there.... stock in BIS much?
 
Check out Friedberg's website: http://www.cosmeticsurgeryanesthesia.com

This guy redefines the word "jackass"- what a freaking sellout-I love the picture of him with his hybrid vehicle; by the way, thanks for bringing the dinamap to stanford- enjoy your steak dinner at aspect
 
cchoukal said:
I mean, aside from going through the chest wall through the LV or aorta during a boob job, it seems pretty hard to kill someone from the cosmetic surgery itself.
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Not true. Overly aggressive plastic/cosmetic surgeons can place their patients at great risk by being too extensive with their resections/liposuctions/reconstructions. I reviewed a case last year where a surgeon took a total of 20 pounds off a patient by bilateral breast reduction, tummy tuck, lipo hips/thighs, and lift. The patient received 4 liters IV fluids with documented maintenance of 50 cc/h urine output (greater than 0.5 cc/kg/h for this patient).

Young patient and otherwise healthy (23 years old). On post op day 1 she was hypotensive, tachycardic, nauseated, and edematous. She coded twice and suffered mild anoxic brain injury without permanent sequelae. Her preop Hct was 41.7 and on POD 1 was 23.2.

In a patient such as Kanye's West's mom where there might have been a preexisting heart condition, such wide hemodynamic swings not adequately treated in a postop facility may well have led to her demise.
 
Minimally invasive anesthesia (MIA)® (BIS = 60-75) gives patients what they desire from general anesthesia with the lesser trespass of sedation," asserts Friedberg.

"During MIATM, muscle tone in the legs is preserved in addition to pre-emptive analgesia being provided. Preserving leg muscle tone along with the ability to rapidly walk after surgery because of minimal postoperative pain are among the significant advantages of MIATM compared to general anesthesia," says Friedberg.
Click to expand...

Why is MIA a registered trademark? WTF

What is MIATM?

D-bag definitely.


from his FAQ's :
Who will be giving my anesthesia?
In an office-based setting, it could be the surgeon's secretary (at the surgeon's direction), a registered nurse with technical training in anesthesia, or an anesthesiologist (an MD specializing in the medical practice of anesthesiology).
Click to expand...

That cannot be good.
 
CremeSickle said:
I have lost ALL respect for Friedberg when i read this in the second article:
Click to expand...
My respect went when I ventured to the website (rubbernecking at the trainwreck he obviously is) and read (my paraphrase) something along the lines of "I avoid the one size fits all protocol that everyone else uses, I use the best anesthesia for that patient at that time" but in the same sentence says he only uses prop-ketamine. Hello Pot, I'm Kettle, veterinary anaesthetist.
 
From the second web site, "More information can be found at http://www.cosmeticsurgeryanesthesia.com, a patient-oriented, non-commercial web site. "

Non-commercial?!?! The whole thing is one giant commercial. Do I really care that he drives an electric car in smoggy Los Angeles? I'll admit that I don't read "Outpatient Surgery Magazine," but it doesn't strike me as a high-quality, peer-reviewed journal, though I could be wrong. I don't see any articles from good peer-reviewed journals. I also wonder how much he gave to the Congressman's campaign in return for that "Congressional Award."

UT's right on. Liposuction in particular, especially by someone who doesn't really appreciate its potential, can be a very dangerous procedure. Big fluid shifts. Underappreciated EBL.
 
If you want to learn how to decrease PONV, you can hire Barry L. Friedman, MD, Writer of Letters to the Editor!

Or read the Apfel paper in NEJM 2004. Yikes.
 
sometimes liposuction is done with "tumescent" solution, which contains lots of lidocaine...most of it is sucked out, however, there are a few case reports where people died form overdoses...sometimes 12-36 hours afterwards, b/c of reabsorption/metabolism. there is some suggestion that genetic differences in hepatic clearance becomes very important here.

this is well documented and the total dose of lidocaine should be
 
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The essence of leadership is that you have a vision.
- Theodore Hesburgh

Having done my share of 'flames' on the internet, I was quite amused by the comments above. All are perfectly entitled to their opinions. Over the past 15 years, I have heard all of them and even worse.

In Hollywood, there is no bad publicity as long as they spell your name correctly. 12 of 13 posts did so.

I also thank yesterday's 49 visitors to xxxxx as well as the 7 so far until 6 a.m. today. I look forward to more web traffic as that is my primary benchmark. The only truly commercial aspect for the web site is the offer of my book, Anesthesia in Cosmetic Surgery for sale. I chose the '.com' suffix to avoid violating the '.org' guidelines because of the link to Aspect.

For those who did not read my disclaimer, I repeat that I am not employed by Aspect, and am neither a stock holder nor a paid consultant for them. I am, however, quite enthusiastic about BIS monitoring and have used it in my boutique practice for the past 10 years.

Following the death of Olivia Goldsmith in 2004, my publisher discovered there was no book in the filed of cosmetic surgery anesthesia. They selected me first of the then 40,000 US anesthesiologists to write and edit a comprehensive text in the field. When I asked 'Why me?' they responded with 'you are the only one doing anything different and writing about it.' No one will ever confuse me with Crawford Long. 🙂

Minimally invasive anesthesia® for minimally invasive surgery (MIA4MIS) (posted on the site) was an article I wrote for the trade journal Outpatient Surgery Magazine in Feb 2004.

The article, despite not being a peer-reviewed one, is cited on the web site of the Karolinska Institute, the pre-eminent Swedish medical center. Obviously, the Swedes realize that clinical utility is not limited to Level I studies. The point of Level I studies is reproducibility. Perhaps this is why people who try it are so enthusiastic about it. It's simple and it works ... duh.

I thought the logic of MIA4MIS was overwhelming so I proceeded to trademark the phrase to protect my intellectual property. The acronym 'MIA' is not trademarked and may therefore only be referred to as 'TM' supra-script. My apologies to those who were understandably confused by the failure for the supra-script to appear.

As far as my colleague Chrisitan Apfel, he has been citing "Propofol-ketamine technique, dissociative anesthesia for office surgery: a five year review of 1264 cases." Aesthetic Plastic Surgery 23:70,1999 as an example of what happens to PONV when both opioids and stinky gases are avoided.

"Excellence is an art won by training and habituation. We do not act rightly because we have virtue or excellence, but rather we have those because we have acted rightly. We are what we repeatedly do. Excellence, then, is not an act but a habit."
-- Aristotle

I am only an email or phone call (web site contact) away for those desiring support in the pursuit of better outcomes.

Happy Thanksgiving! I shall toast the cranks with some vinegar and water.:laugh:
 
Cartman learned a new trick...he can make a smiley.
 
What a freakin' knob! :laugh: Dude, chill on the gratuitous quotes.
 
Aghast, I could not think of a more appropriate name. Trademarking your approach smacks of the "Ether Wars" of last century. There is no better way to trivialize yourself in medicine than to protect your "intellectual rights."

Good luck with that.
 
aghast1 said:
The essence of leadership is that you have a vision.
- Theodore Hesburgh

Having done my share of 'flames' on the internet, I was quite amused by the comments above. All are perfectly entitled to their opinions. Over the past 15 years, I have heard all of them and even worse.

In Hollywood, there is no bad publicity as long as they spell your name correctly. 12 of 13 posts did so.

I also thank yesterday's 49 visitors to xxxxxx as well as the 7 so far until 6 a.m. today. I look forward to more web traffic as that is my primary benchmark. The only truly commercial aspect for the web site is the offer of my book, Anesthesia in Cosmetic Surgery for sale. I chose the '.com' suffix to avoid violating the '.org' guidelines because of the link to Aspect.

For those who did not read my disclaimer, I repeat that I am not employed by Aspect, and am neither a stock holder nor a paid consultant for them. I am, however, quite enthusiastic about BIS monitoring and have used it in my boutique practice for the past 10 years.

Following the death of Olivia Goldsmith in 2004, my publisher discovered there was no book in the filed of cosmetic surgery anesthesia. They selected me first of the then 40,000 US anesthesiologists to write and edit a comprehensive text in the field. When I asked 'Why me?' they responded with 'you are the only one doing anything different and writing about it.' No one will ever confuse me with Crawford Long. 🙂

Minimally invasive anesthesia® for minimally invasive surgery (MIA4MIS) (posted on the site) was an article I wrote for the trade journal Outpatient Surgery Magazine in Feb 2004.

The article, despite not being a peer-reviewed one, is cited on the web site of the Karolinska Institute, the pre-eminent Swedish medical center. Obviously, the Swedes realize that clinical utility is not limited to Level I studies. The point of Level I studies is reproducibility. Perhaps this is why people who try it are so enthusiastic about it. It's simple and it works ... duh.

I thought the logic of MIA4MIS was overwhelming so I proceeded to trademark the phrase to protect my intellectual property. The acronym 'MIA' is not trademarked and may therefore only be referred to as 'TM' supra-script. My apologies to those who were understandably confused by the failure for the supra-script to appear.

As far as my colleague Chrisitan Apfel, he has been citing "Propofol-ketamine technique, dissociative anesthesia for office surgery: a five year review of 1264 cases." Aesthetic Plastic Surgery 23:70,1999 as an example of what happens to PONV when both opioids and stinky gases are avoided.

"Excellence is an art won by training and habituation. We do not act rightly because we have virtue or excellence, but rather we have those because we have acted rightly. We are what we repeatedly do. Excellence, then, is not an act but a habit."
-- Aristotle

I am only an email or phone call (web site contact) away for those desiring support in the pursuit of better outcomes.

Happy Thanksgiving! I shall toast the cranks with some vinegar and water.:laugh:
Click to expand...

Your techniques are not novel or unknown to the vast cadre of teaching and practicing anesthesiologists in this country. We employ them on a daily basis and taylor our anesthetics to the individual just as you do, even at the resident level. You do not hold dominion over our profession in any way, shape, or form. Your ideas are not earth-shattering or even mildly innovative, for that matter.

Most of us can see you are simply standing on the shoulders of giants and claiming some special knowledge that you do not actually possess, all for self-gain . Coining (and then trademarking) a meaningless term - meaningless - serves only one purpose: self-promotion and hucksterism. This is what makes you a douchebag.

You have nothing of value to add here. Please go away.

-copro
 
leave the guy alone. If he can assert that he is better than any other anesthesiologist and sell it to the mass and people buy it.. More power to him. Isn't that what all of us want to do?Market ourselves to differentiate ourselves from other providers. Isnt that what groups who hold exclusive contracts do?
 
The lady probably died of a pulmonary embolism, perhaps the most feared complication faced in anesthesia. I don't fear myocardial ischemia/infarction, excessive blood loss or can't intubate situations. But a massive pulm embolism is some wicked shiit.... Regards, ----Zippy
 
johankriek said:
Isn't that what all of us want to do?Market ourselves to differentiate ourselves from other providers.
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Yeah, if we actually are doing something different/better.

What this douchebag's implicit assertion is that he is better than you, and that you are somehow going to have worse outcomes than he because he of it, and that you are providing cookie-cutter anesthesia, which is at the very least overkill with more adverse side effects or, worse, dangerous.

If he was actually doing something unique and/or better, more innovative, stuff we aren't actually already routinely doing, etc. then he'd have a leg to stand on. As it is, he's breeding unnecessary competition via self-aggrandizement and, maybe more sinisterly, misleading the public into believing that his techniques are somehow unknown to the profession, not fraught with their own potential perils, and inherently "better" than what is already being done - the exact same techniques - elsewhere.

He is a huckster. If you are implying that you support hucksterism, Johan, then our profession is in deep ****.

-copro
 
guys you have to give him credit for at least posting on this forum considering how you guys have been treating him... that takes a lot of guts.

at the same time - he is also a classic example of what went wrong with california - where medicine has been elevated to the status of a "marketing a brand"... the patients in LA will buy anything as long as it is well marketed - and friedman seems to understand that concept very well...

just like the doctors in LA who market themselves as Harvard trained even though they only did a 2 day CME at the Brigham and Women's....

prop-ketamine has been done before and is still being done - but there are a lot of risks with dissociative anesthesia...
 
zippy2u said:
The lady probably died of a pulmonary embolism, perhaps the most feared complication faced in anesthesia. I don't fear myocardial ischemia/infarction, excessive blood loss or can't intubate situations. But a massive pulm embolism is some wicked shiit.... Regards, ----Zippy
Click to expand...

Didn't she die a day or two postop? This was definitely not an intraoperative death, so the MIA crap is entirely self-serving.
 
Is that everything in cali tensema?

Seems to me the whole state is about marketing a false dream.
 
Tenesma said:
guys you have to give him credit for at least posting on this forum considering how you guys have been treating him... that takes a lot of guts.

at the same time - he is also a classic example of what went wrong with california - where medicine has been elevated to the status of a "marketing a brand"... the patients in LA will buy anything as long as it is well marketed - and friedman seems to understand that concept very well...

just like the doctors in LA who market themselves as Harvard trained even though they only did a 2 day CME at the Brigham and Women's....

prop-ketamine has been done before and is still being done - but there are a lot of risks with dissociative anesthesia...
Click to expand...



Although I think this Friedman guy is kind of a self-important tool you have to admit that he is a marketing genius. 250 ASA 1-2 cases a year and he is living fat in LA????- sign me up.

Tenesma- could you elaborate a little with the risks you mention of PK? I use this cocktail almost daily and have had 0 complications... I would be interested if I am missing something. Admittedly I keep the total ket dose to less than 50 mg total so perhaps I am not delivering true dissociative anesthesia. Also I never give droperidol to these patients.

Usually give 2-4 of versed with glyco preop, in the room mix PPF, ket, lido in 100 cc bag on mini drip, run wide open until pt closes eyes, cut rate in half, and wait for surgeon to inject local- 9/10 times not even a flinch. No narcs, no antiemetics- shut gtt off as dressings are going on- pts usually awake and moving themselves over to stretcher post op- bypass PACU- out of ASU within 30 min- no nausea, rarely pain that cant be controlled with PO meds. Have had MANY repeat pts who request "whatever you did the last time".

Thanks.
 
fval28 said:
Usually give 2-4 of versed with glyco preop, in the room mix PPF, ket, lido in 100 cc bag on mini drip, run wide open until pt closes eyes, cut rate in half, and wait for surgeon to inject local- 9/10 times not even a flinch. No narcs, no antiemetics- shut gtt off as dressings are going on- pts usually awake and moving themselves over to stretcher post op- bypass PACU- out of ASU within 30 min- no nausea, rarely pain that cant be controlled with PO meds. Have had MANY repeat pts who request "whatever you did the last time".
Click to expand...

That's exactly the point. There is nothing unique or particular groundbreaking that this dude is doing. Anesthesia on ASA 1-2 patients is different than on an ASA 3. We're talking bascially cosmetic procedures on an otherwise healthy population.

The risk is that you are still giving a general anesthetic. You can't rely on the "minimally invasive" nature of it (whatever the hell that means). You can lose an airway, still get laryngo/bronchospasm, have an unstable patient, have the patient move during the procedure, etc., etc., etc. To suggest that this is an inherently superior technique - as well as the idea that it's not "cookie cutter", as this douchebag suggests - minimizes the fact that it is a general anesthetic and still has all the risks inherent as such.

In short, he is grossly and unabashedly misinforming and misleading the public. 👎

-copro
 
I think it's just good marketing. But "minimally-invasive anesthesia" just sounds cheesy to me no matter what. 🙂
 
Vinnik CA: An intravenous dissociation technique for outpatient plastic surgery: tranquility in the office surgical facility. Plast Reconstr Surg 67:199-205, 1981.

Vinnik, a Las Vegas plastic surgeon, clearly enunciated that the patient must first be asleep with incremental diazepam doses before administering the ketamine to block ketamine hallucinations. He used a 75 mg initial dose.

In 1981, few in the anesthesia community read the plastic surgery literature. Fewer still would have given Vinnik credence for knowing something they didn't; i.e. how to prevent hallucinations from ketamine.

Ketamine is second generation phencyclidine phosphate (PCP). PCP was marketed as Serenyl by ParkeDavis in 1958 but quickly withdrawn because of adverse experience.

I heard Vinnik lecture in Newport Beach in December 1991 at a FASA meeting. I visited his facility in March 1992 before beginning my case series on March 26, 1992.

I was tremendously excited with my initial results. My first propofol ketamine (PK) publication (letter to the editor) was in the Oct. 1992 SAMBA Newsletter.

I received an unbelievable amount of withering criticism, of course by those who had abandoned ketamine or never used it in the first place.

The well earned reputation of ketamine is that it caused hallucinations, dysphorias and/or flashbacks in an unpredictable 20% of patients. Also, ketamine was reported to cause hypertension and tachycardia.

When I searched the literature, pre-internet, I could only find Guit's 1991 propofol ketamine TIVA paper. He was mixing the agents (TIVA) as opposed to administering them separately as I did (MAC) following Vinnik's paradigm.

I soon realized that there was nothing in the literature to support my practice in the event of an untoward event. There were no shortage of academicians eagerly awaiting the opportunity to be 'expert' witnesses.

Accordingly, I published in the peer-reviewed literature:

my first 25 cases:

Friedberg BL: Hypnotic doses of propofol block ketamine induced hallucinations. (letter) Plastic & Reconstructive Surgery 91:196,1993.

my first 50 cases:

Friedberg BL: Propofol-ketamine technique. (article) Aesthetic Plastic Surgery 17:297,1993.

and had a poster demonstration:

SAMBA Eighth Annual Meeting, Marriott Camelback Inn Resort in Scottsdale, AZ. Abstract “Propofol-Ketamine Technic, Fifty Cases Presented,” a poster presentation. 04/22-25/93

What you may fail to appreciate is how difficult the task of publishing in the anesthesia peer-reviewed literature if a) one is not in the academic community, b) have any level of recognition or pre-existing authority.

Time rolled on and the critics flocked: 'wouldn't do it, shouldn't do it , couldn't do it,' they exclaimed. 'Bad, bad, bad, unsafe.'

One US based anesthesiologist even asserted he was doing propofol ketamine before propofol was introduced to the North American market.

To all those claiming they did it before me, I responded, "You don't need a publication to establish you were doing propofol ketamine MAC before me. Just show me an anesthetic record that predates my work and I will gladly credit you." Strangely, no one came forward.

From Copro: "Your techniques are not novel or unknown to the vast cadre of teaching and practicing anesthesiologists in this country. We employ them on a daily basis and taylor our anesthetics to the individual just as you do, even at the resident level. You do not hold dominion over our profession in any way, shape, or form. Your ideas are not earth-shattering or even mildly innovative, for that matter."

I believe the word is spelled 'tailor.'

FYI, 50% of all published articles are never subsequently cited. My work has been cited in 36 peer-reviewed journals and 12 anesthesia textbooks, including Miller's 2005 Anesthesia and Barasch' 2005 Clinical Anesthesia, 5th ed.

One of the anesthesia legends remarked to me at a 1995 SAMBA meeting, "If it isn't in a hospital , isn't it all ambulatory anesthesia?" In 1996 years before either ASA or SAMBA recognized it as a separate venue from ASCs, I founded SOFA, Society for OFfice anesthesiologists and merged it with SOBA in 1998. Ignorance of history is still ignorance.

I am very comfortable with my contribution to patient safety and better outcomes assuring my place in anesthesia history. I repeat my challenge to my critics, "Show me an anesthetic record that predates my work and I will credit your contribution."

At this year's ASA, I learned that one of my bitterest critics, who is also politically prominent, is performing my technique with the usual reproducible outcomes. I was thrilled. "Let her give the lecture," I remarked.

Yours for better and reproducible outcomes,

aghast1

FWIW, ad hominem attacks are not the mark of the educated person.
 
When I searched the literature, pre-internet, I could only find Guit's 1991 propofol ketamine TIVA paper. He was mixing the agents (TIVA) as opposed to administering them separately as I did (MAC) following Vinnik's paradigm.


So, let me get this straight,you are saying that if you give a benzo first and make them sleep, THEN give ketamine- they are under MAC-- but if you mix propofol and ketamine together and infuse them it is GA???

I would argue that both are GA (TIVA) and you are arguing semantics. Are your "MAC" patients responsive to noxious stimuli, are their airway reflexes intact, are the able to verbally express their level of comfort/ discomfort with the procedure they are undergoing?

If the answer to any of these is no, then they are under GA, not MAC, and if the answer to any of these questions is yes, then I think you are lucky to have a plastic surgeon who will let you provide anesthesia to 250 of his patients a year.

As I wrote before, I routinely use PK and have great outcomes, but I also describe it to the patient, surgeon and OR staff as it is, TIVA not MAC. Anything less is not truthful.
 
FromAnesthesia in Cosmetic Surgery Cambridge University Press 2007
Chapter 1 Propofol ketamine with bispectral (BIS) index monitoring,
Table 1-4

BIS Level of Sedation/Anesthesia

98-100 Awake
78-85 Minimal sedation ('anxiolysis')
70-78 Moderate ('conscious') sedation
60-70 Deep sedation
45-60
with systemic analgesia General anesthesia
<45 OVERDOSED

Minimally invasive anesthesia(MIA)® is BIS 60-75 or moderate to deep sedation with adequate local analgesia.

MIA provides the illusion of GA with the lesser trespass of sedation. Of course, one cannot trespass 'minimally' unless one know how much one is trespassing in the first place. One cannot do this reliably with clinical signs.

Table 1-4 provides the airway algorithm. NO intubation has been required for over 3,000 patients in >15 yrs. Of course, one has to know how to recognize ketamine associated laryngospasm. Hint: rarely is it the 'crowing' noise.

The full mind has no room for knowledge.
Zen quote
 
aghast1 said:
I believe the word is spelled 'tailor.'

FYI, 50% of all published articles are never subsequently cited. My work has been cited in 36 peer-reviewed journals and 12 anesthesia textbooks, including Miller's 2005 Anesthesia and Barasch' 2005 Clinical Anesthesia, 5th ed.


FWIW, ad hominem attacks are not the mark of the educated person.
Click to expand...


I believe the word is spelled 'Barash'. 🙄
 
aghast1 said:
FromAnesthesia in Cosmetic Surgery Cambridge University Press 2007
Chapter 1 Propofol ketamine with bispectral (BIS) index monitoring,
Table 1-4

BIS Level of Sedation/Anesthesia

98-100 Awake
78-85 Minimal sedation ('anxiolysis')
70-78 Moderate ('conscious') sedation
60-70 Deep sedation
45-60
with systemic analgesia General anesthesia
<45 OVERDOSED

Minimally invasive anesthesia(MIA)® is BIS 60-75 or moderate to deep sedation with adequate local analgesia.

MIA provides the illusion of GA with the lesser trespass of sedation. Of course, one cannot trespass 'minimally' unless one know how much one is trespassing in the first place. One cannot do this reliably with clinical signs.

Table 1-4 provides the airway algorithm. NO intubation has been required for over 3,000 patients in >15 yrs. Of course, one has to know how to recognize ketamine associated laryngospasm. Hint: rarely is it the 'crowing' noise.

The full mind has no room for knowledge.
Zen quote
Click to expand...

?
Thanks for the clarification but i suppose you know that ketamine doesn't influence BIS reading so your table is not applicable...
No intubation? but are you using LMA's?

On a side note I know of a surgi-center which performs plastic surgeries with a midaz/sufenta MAC administered by the room nurse... so anything is possible.
 
dhb said:
On a side note I know of a surgi-center which performs plastic surgeries with a midaz/sufenta MAC administered by the room nurse... so anything is possible.
Click to expand...
Then it's conscious sedation, not MAC. Monitored ANESTHESIA care implies the presence of an anesthesia provider.
 
Aghast, I suppose that trademarking your approach is appropriate if you are trying to drum up business. Your MIA whatever sounds nice, if you happen to be a patient undergoing an office procedure. I find that what works for me when I have a nervous patient is to tell them what is really important. That I am a Board-Certified anesthesiologist with years of training and years of experience. That I will be completely attentive to them throughout the case and give them my best care that I can. I tell them that I make no guarantees, except the guarantee that I will do by best. No talismans, no gimmicks, no tricks. Just honest concern. People seem to respond well to that.

I did not see the media piece regarding the patient death. I hope that someone's misfortune wasn't used as an opportunity to scare the public and get yourself a plug.

By the way, I agree that ketamine is a great drug, especially when used in an office setting with great analgesia properties. Most of my group of 50 anesthesiologists use it regularly.
 
"Aghast, I suppose that trademarking your approach is appropriate if you are trying to drum up business. Your MIA whatever sounds nice, if you happen to be a patient undergoing an office procedure. I find that what works for me when I have a nervous patient is to tell them what is really important. That I am a Board-Certified anesthesiologist with years of training and years of experience. That I will be completely attentive to them throughout the case and give them my best care that I can. I tell them that I make no guarantees, except the guarantee that I will do by best. No talismans, no gimmicks, no tricks. Just honest concern. People seem to respond well to that."

"Your MIA whatever sounds nice, if you are trying to drum up business."

Sorry, dude, that was never my intent. As you may have already observed, I have a boutique practice of 250-300 cases a year. Quite pleased with my practice.

Patient safety and better outcomes particularly for PONV and postop pain has always been the goal. I am quite pleased that so many have taken up at least some variation of propofol ketamine, as there are many.

My patients learn that I, too, am a board certified anesthesiologist, 30 years in practice with the last 15 exclusively in office based cosmetic surgery anesthesia. Since December 1998, my premedication has been 0.2 mg po clonidine 30-60 minutes preop. Decreasing the patient's endogenous catecholamine levels is a very sneaky way to produce tranquility, ease induction, maintenance and emergence. Less anxious patients have less postop pain. Friedberg BL, Sigl JC: Clonidine premedication decreases propofol consumption during bispectral (BIS) index monitored propofol-ketamine technique for office based surgery. (article) Dermatologic Surgery 26:848,2000. My patients get to touch the BIS sensor and see the BIS on the cover of my book. The BIS monitor is not a talisman, gimmick, or trick. They are also quite reassured that I will be guiding my dosing based on their brain's individual feedback.

"Your MIA whatever sounds nice, if you happen to be a patient undergoing an office procedure."

Actually, the US military has adopted my technique for use in the field hospitals in Iraq & Afghanistan because they do not require an anesthesia machine or large quantities of oxygen. For this contribution, my local Congressman, John Campbell, gave me a Congressional recognition certificate. FWIW, I had never before contributed to his campaign and he never asked me for a contribution as a quid pro quo for the award.

"I did not see the media piece regarding the patient death. I hope that someone's misfortune wasn't used as an opportunity to scare the public and get yourself a plug."

My only benchmark is driving people like yourself and others to the web site to expose them to my work for their patients' benefit.

To spare you the 'effort' of Google-ing 'Donde West" here is the first press release:

"Donde West death highlights UNNECESSARY RISK of general anesthesia for cosmetic surgery," asserts Dr. Friedberg, a globally recognized leader in cosmetic surgery anesthesia.

Corona del Mar, CA Thursday November 15 2007

In 2004, Olivia Goldsmith, author of the First Wives' Club, died during cosmetic surgery. More recently, Dr. Donde West, mother of rapper Kanye West, died following cosmetic surgery.

"Aside from post-mastectomy reconstruction, there are NO medical reasons for cosmetic surgery. Therefore, no avoidable anesthesia risks, like those associated with general anesthesia, are acceptable," claims Dr. Barry L. Friedberg.

"Since all cosmetic procedures can be performed under local anesthesia only, any and all additional anesthetic agents must be selected and given with the utmost care," says Friedberg.

"Most patients desire not to hear, feel or remember their surgical experience, a condition often associated with the state of general anesthesia. To accommodate patients' wishes, general anesthesia is most often given for cosmetic surgery," states Friedberg.

According to Aspect Medical Systems, makers of the BIS monitor, the sleep portion of general anesthesia ideally occurs at 45-60 on a scale of 0-100. "Minimally invasive anesthesia (MIA)&#174; (BIS = 60-75) gives patients what they desire from general anesthesia with the lesser trespass of sedation," asserts Friedberg.

"During MIA, muscle tone in the legs is preserved in addition to pre-emptive analgesia being provided. Preserving leg muscle tone along with the ability to rapidly walk after surgery because of minimal postoperative pain are among the significant advantages of MIA compared to general anesthesia," says Friedberg.

General anesthesia for cosmetic surgery is not only unnecessary but also fraught with potentially lethal consequences, like pulmonary embolism, vomiting with aspiration, and respiratory arrest secondary to postoperative narcotic pain medications. "All of these potential complications are avoided with MIA," states Friedberg.

More anesthesia providers are recognizing the advantages of MIA. Both surgeons and anesthesia providers need to be asked to provide it to optimize patient safety for cosmetic surgery.

Barry L. Friedberg, M.D. has been in active practice exclusively in office-based anesthesia for cosmetic surgery since 1992. He has published 30 letters to the editor, 14 articles and 6 book chapters including 3 in Anesthesia in Cosmetic Surgery by Cambridge University Press.

More information can be found @ xxxxxxxxxxxxxx, a patient oriented, non-commercial web site.

and the follow-up release:

"Donde West likely killed by need to control postop pain after cosmetic surgery," states Dr. Barry Friedberg.

Corona del Mar, CA Monday, November 19, 2007

The autopsy results for Donde West, mother of rapper Kanye West, were reported as inconclusive. What does &#8216;inconclusive' mean? There were no physical findings to explain her death.

Examples of physical findings are:

1) blood clot in the lung veins
2) heart attack
3) vomit in the breathing tubes
4) fluid in the lung tissue

West was reportedly found not breathing (respiratory arrest) after cosmetic surgery that included two major procedures: abdominoplasty (&#8216;tummy tuck') and breast reduction.

Narcotics (opioids) like codeine or Vicodin (synthetic codeine) are commonly used to manage postop pain. The worst side effect of these medications is a stoppage of breathing when too high a blood level is reached after too much pain medicine is taken.

"If West had sleep apnea as a pre-existing condition, even average doses of narcotics could easily prove fatal. The pending toxicology study of her blood levels might then be reported as within &#8216;reasonable' levels for patients without sleep apnea," claims Friedberg.

On rare occasion, patients having abdominoplasty with breast reduction have been admitted to a hospital for continuous intravenous (IV) narcotic therapy to control postop pain.

"For cosmetic surgery, I pioneered BIS-monitored, propofol ketamine IV sedation known as minimally invasive anesthesia (MIA)&#174;. MIA mimics general anesthesia but, because of the lesser drug trespass, is safer and simpler. No deaths or hospital admissions have occurred with MIA in a decade," says Friedberg.

"Unlike general anesthesia, MIA prevents the pain of the local anesthetic injection from reaching the brain. This phenomenon is called pre-emptive analgesia. No patients, including those having abdominoplasty and breast reduction, under MIA have needed narcotics (IV or oral) for postop pain in 10 years," states Friedberg.

"It was unlikely that either the two surgeries or the 8 hour surgery caused West's death. More likely, it was the manner in which the surgery was performed; i.e. under general anesthesia which does not reliably produce pre-emptive analgesia and, therefore, often necessitates postop narcotics to manage pain," claims Friedberg.

Barry L. Friedberg, M.D., a board certified anesthesiologist, has been exclusively practicing office-based anesthesia for cosmetic surgery since 1992. In 2004, he was chosen first among 40,000 US anesthesiologists to write Anesthesia in Cosmetic Surgery, the first textbook in the field.

More information can be found @ xxxxxxxxxx, a patient oriented, non-commercial web site.

Source: Cosmetic Surgery Anesthesia

"By the way, I agree that ketamine is a great drug, especially when used in an office setting with great analgesia properties. Most of my group of 50 anesthesiologists use it regularly."

I reiterate my pleasure in learning this information. Keep up the great work.👍

Your pal in SoCal.

aghast1

 
Trisomy13 said:
I believe the word is spelled 'Barash'. 🙄
Click to expand...

Happy you read that far in my post.
I stand corrected.
Hopefully, you learned something useful.
I look forward to reading your references in Barash and Miller.😍

aghast1
 
aghast1 said:
Happy you read that far in my post.
I stand corrected.
Hopefully, you learned something useful.
I look forward to reading your references in Barash and Miller.😍

aghast1
Click to expand...



i look forward to reading your letters to the editors.


honestly, if you have good science, it's not impossible to be published in respected peer-reviewed journals. i did it several times, before medical school.



(insert pretentious school-yearbook-quality quote here)
 
UTSouthwestern said:
Not true. Overly aggressive plastic/cosmetic surgeons can place their patients at great risk by being too extensive with their resections/liposuctions/reconstructions. I reviewed a case last year where a surgeon took a total of 20 pounds off a patient by bilateral breast reduction, tummy tuck, lipo hips/thighs, and lift. The patient received 4 liters IV fluids with documented maintenance of 50 cc/h urine output (greater than 0.5 cc/kg/h for this patient).

Young patient and otherwise healthy (23 years old). On post op day 1 she was hypotensive, tachycardic, nauseated, and edematous. She coded twice and suffered mild anoxic brain injury without permanent sequelae. Her preop Hct was 41.7 and on POD 1 was 23.2.

In a patient such as Kanye's West's mom where there might have been a preexisting heart condition, such wide hemodynamic swings not adequately treated in a postop facility may well have led to her demise.
Click to expand...

UT,

Agree with you a 100%,plastic surgeries can very quickly take ugly turns intra-op ,especially when they turn out to be longer procedure.On an avg we tend to under-estimate the blood loss and insensible fluid losses.
For Breast reconstruction the whole body is exposed.....we had a patient who got so hypothermic that the only way out was warm gastric lavages.
I have seen many of these patients develop ARF post op,and few hypotensive requiring fluid resuscitation
 
From the Associated Press
9:07 PM PST, November 20, 2007

Dr. Adams said he prescribed West Vicodin after the surgery.

I mentioned this possibility in my Nov.19 press release. The only remaining question was whether she ingested toxic levels or was an especially sensitive patient (i.e. sleep apnea).

Having worked with Adams on a couple of cases, I knew his preference for GA. However, when he worked with me, he was obliged to participate in minimally invasive anesthesia. Were the pursuit of money my primary goal in practice, I would have made a great deal more over the past 15 years by acceding to the demand for GA for cosmetic surgery. Since GA is clearly not as safe* as MIA, I have declined to administer GA for cosmetic surgery. I will only work with surgeons who will participate with MIA for the patient's benefit. Safety & better outcomes >>> dollars.

The pre-emptive analgesia provided with MIA makes the use of postop opioids a very rare, not routine, requirement to mange postop pain. Also, with MIA, and multiple site surgery, 50 cc 0.25% bupivicaine is diluted to 100 cc. 50ccs are deposited in the abdomen (before closing or retrograde through the drains) and 25 ccs deposited in each breast before closure. The key is not to exceed 125 mg total dose of bupivicaine. If one needs more than 50 ccs, simply dilute to the required volume to avoid cardiotoxicity from bupivicaine.

Your pal in SoCal,

aghast1

*Known complications of GA include pulmonary embolism (secondary to venous stasis esp. in pelvic veins), aspiration, negative pressure pulmonary edema, wrong site intubation (with attempted OET), PONV, postop pain management, & malignant hyperthermia to name a few. None of these have occurred with MIA in my hands or others from around the globe performing PK/MIA.
 
cchoukal said:
Anyone know who this guy in the 2nd story is? Other than a schill for Aspect? The guy is listing "letters to the editor" on his CV. Impressive.
Click to expand...


My thoughts exactly.
 
I can't believe the responses from some of the so called professionals here. 👎

I give Friedberg total credit. If he wants to market his technique, who cares. It doesn't hurt any of you except maybe your over inflated egos. I have been using a very similar technique for a long time now. I never needed to market it but so what, wish I'd have thought of it. Those of you that don't use ketamine are missing out, IMHO. Thats fine, there are many ways to skin a cat.

We can all argue the semantics as well, MIA, TIVA, MAC, GA. I am sort of a sticklier for proper terms and if they don't respond (respond is a very general and loose term) then its a GA to me. Many peoples definition of response is different. If you call it MAC you get paid less. When the insurances get tricky they will find a way to pay less for MIA as well and then it will be called something else, maybe light GA.
 
MAC is only a billing term which has replaced "anesthesia standby". It has nothing to do with a 'type' of anesthesia though it is incorrectly used that way. dhb is totally correct.
 
Noyac said:
I have been using a very similar technique for a long time now.
Click to expand...

That's exactly the point!

Noyac said:
I never needed to market it but so what, wish I'd have thought of it.
Click to expand...

When you start "marketing" and "trademarking" already established and widely used techniques, you are moving out of the realm of medicine and into one of hucksterism...

Oh, wait! Nevermind. Why fight 'em if you can join 'em? So, I just trademarked a technique. It's called Patient-Friendly Anesthesia™ and anyone who tries to use that name without my permission will be taken to court for trademark infringement. A guy's gotta protect his intellectual property, you know, in spite of the fact that I'm not really doing anything unique or especially different than many of you are already doing in your daily practice. In fact, I'll just make a website claiming you all are a bunch of *******es who don't really know how to do anesthesia. Because, I'm smarter than you.

You see, I'm going to tell you what I do (roughly) so I can claim that you are copying my techniques if you use my trademarked names. I'll use propofol, remifentanil and Precedex infusions during cosmetic surgery procedures, but will deny that I do "cookie cutter" anesthesia and then claim that I individualize all of my anesthetics. And, I'll also ask the surgeon to inject some Gentle Local™, which will be a propietary mix of commonly used and widely available already-on-the-market local anesthetics so there's minimal incisional pain afterwards. My patients will always wake up very nicely from this technique, as I've done it so many times I know this for fact. I've also read a bunch of papers others have published and assimilated this technique, and written my own papers based on them and used the hard work of others to my own advantage. Besides, I'm not really compelled to disclose if and when I have bad outcomes because this is now a sales/marketing program I'm running, and I wouldn't want to hurt my business. Anyhow, I know it is very low risk because I'm a great anesthesiologist and I likewise don't suffer from humility or the ability to question the limits of my own abilities. Therefore, I'm clearly not biased. And, forget the fact that no matter what I call it this is still general anesthesia. I won't tell you my exact mixes or technique, because that's part of my trademarked secret. After all, I'm smarter and more clever than all of you and I deserve to have my special skills protected by law. I'll do 1 to 1.5 of these types of cases per day and charge the patient a sh*tload of money for my services, after I publish some bullsh*t papers, go on the talkshow junket, sit for media interviews, and appear on a bunch of daytime talkshows promoting myself. I'm going to be the Mehmet Oz of anesthesia.

By the way, if any of you try to use these techniques and/or call them Patient-Friendly Anesthesia™ or Gentle Local™ without acknowledging me, I'll sue your ass. I gotta protect my intellectual property, you know. You're now publicly on notice. But, hey, if you want to use these names and pay me a royalty, that's fine with me.

Do you understand now, Noyac?

-copro
 
dhb said:
I agree, however i don't know of any scientific proof of pre-emptive analgesia unlike decreased hyperalgesia.


jwk: the center offers "anesthesia standby for &#8364; 631" so it's MAC if you pay for it :meanie:
http://www.linea-aesthetica.com/fr/liste_de_prix.htm
Click to expand...

No Level I studies have been performed using dissociative technique.

As far as scientific proof of 'pre-emptive analgesia,' I have none to offer you.

None of my facelift or tummy tuck patients will volunteer for the 'more-likely-to-barf' group.

I did, however, offer funding of a Christian Apfel designed Level I study to 6 different universities. All demurred. Drug companies do have far deeper pockets than do I. 🙁

With a limitations of a mere clinician, my understanding of 'science' and Level I study was to assure the reader of reproducibility.

Clinicans who have followed my teaching have reported the same outcomes; i.e. essentially zero (0.5%) PONV and minimal postoperative pain. (see Testimonials www.cosmeticsurgeryanesthesia.com)👍

Again to the issue of reproducibility, I have successfully performed PK (pre-1997)/MIA for for >3,000 patients in >100 different surgeons' offices.

Not all clinical truth can be found in Level I studies. Note that the Karolinska Institute cited my Feb. 2004 'trade' journal article 'Minimally invasive anesthesia for minimally invasive surgery' on their web site.👍

As far as the money issue goes, I have no objection to people calling MIA GA or anything else if it means they get paid as opposed to not.

My concern goes to the AAAASF (plastic surgeon organization - not much third party billing) regulations that require an anesthesia machine, scavenging and dantrolene if MIA is defined as 'GA.'

Many office based surgery suites cannot realistically provide scavenging, especially now that simply venting to atmosphere is not acceptable.

MIA does not require an anesthesia machine, just O2, suction & Ambu (or other positive pressure device). MIA does not use MH triggering agents (no Sch or stinky gases). These requirements increase the cost of the facility without any increment in patient safety. 15 years without having to 'convert' to GA.

Best regards from your pal in SoCal,

aghast1
 
aghast1 said:
MIA does not require an anesthesia machine, just O2, suction & Ambu (or other positive pressure device). MIA does not use MH triggering agents (no Sch or stinky gases). These requirements increase the cost of the facility without any increment in patient safety.
Click to expand...

My PFA doesn't either. Pay me.

aghast1 said:
15 years without having to 'convert' to GA.
Click to expand...

You are alreayd providing "GA", doctor. The fact that you don't realize this is highly worrisome. Why should I believe that you haven't had any bad outcomes? Because you say so? Pish.

-copro
 
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