Would be honored if you would consider sharing this information with your network of colleagues, friends & trainees.
http://www.sedationconsulting.com/component/content/article/75-uncategor...
Who is the greater fool?
One who thinks they are protecting their patients from pain but still must medicate with opioids post-operatively or one who found a numerically reproducible paradigm to eliminate the need for post-op opioids for 15 years?
Who is the greater fool?
One who has tried the cortical brain monitor & discarded it or one who has turned it into a real time, extremely useful monitor.
Who is the greater fool?
One who continues to give emetogenic anesthetics and ever more expensive anti-emetics or who has entirely stopped giving emetogenic drugs?
When anesthesia is given without a brain monitor (i.e. the 20th century model of anesthesia care), over-medication is always given for fear of under medication or anesthesia awareness.
The customary monitors (EKG, pulse oximeter, & blood pressure) do a fine job of measuring your brain STEM function. However, thinking, hearing, feeling and remembering are CORTICAL functions.
Brain stem measurements are notoriously unreliable measures of your cortical function. Poor or sub-optimal cortical function is revealed in brain fog or POCD.
Before Paul White was retained, as a recognized propofol expert, I was asked, by Murray's attorney, Michael Flanagan, to defend Conrad Murray's care of Michael Jackson.
In Flanagan's attempt to impress me, I was told Murray was such a 'great' doctor he didn't start an IV when performing cardioversion. Flanagan represented that Murray simply put the propofol directly into the patient's vein.
Upon hearing this description of Murray's usual practice, my jaw dropped open & my eyes grew large with astonishment & disbelief.
What does Obamacare share in common with Milo Minderbinder's (an officer in "Catch-22") corporation, wherein everyone has a (worthless) "share?"
Yes, health care is now available to millions more than before, but just try getting it. Or as one cartoon put it succinctly, "Yes, comrade, health care is free in our country, but if you want me to operate with my glasses on, it will be $5,000."
Barry L. Friedberg
Newport Beach
Kudos to Mathews, et al. (1) for more widely disseminating the increased utility of the BIS monitor with trending EMG as a secondary trace. This information has been previously published. (2,3).
Barry L. Friedberg, M.D.
President, Goldilocks Anesthesia Foundation
References
1. Mathews DM, Clark L, Johansen J, et al. Increases in Electroencephalogram and Electromyogram Variability Are Associated with Increased Incidence of Intraoperative Somatic Response. Anes Analg 2012;114:759-770.
Good morning.
Today marks the 20th anniversary of my first propofol ketamine anesthetic.
Not many of our colleagues can claim to have created a new paradigm.
One day, I hope most will see the utility of the nifty 50 for any surgery that breaches the skin.
Patients will be delighted, PACU will notice & facility cost efficiency will increase.
Until that day, I shall be thrilled with my accomplishment.
Dr. Friedberg blog post in NY Times
Paul Krugman Op-Ed: Hurray for health care
see Going Under c Goldilocks anesthesia.
http://www.youtube.com/watch?v=GlQ3Do3b3_I&list=UUJfRG14veFypW1wEqYYgSfA...
youtube video, 'Going Under with Goldilocks anesthesia' has gone viral since being cited by Outpatient Surgery Magazine email blast & eweekly
http://www.youtube.com/watch?v=GlQ3Do3b3_I&list=UUJfRG14veFypW1wEqYYgSfA...