Testimonials

Hi Barry:

Thank you for the autographed copy of your book. It was very thoughtful of you and it will have a special place in my library.

You have made an important contribution to the clinical practice of anesthesiology and this publication should further its use among our colleagues.

Keep up the good work. I am proud of you.

Dr. Friedberg,

I am a CA-2 at Scott and White hospital in Temple, TX and recently read with interest your MIA technique in the book Anesthesia for Cosmetic Surgery.

I am currently doing vascular surgery this month, and our vascular surgeons here have started recently requesting MAC anesthesia for many previously GETA procedures including endovascular thoracic and abdominal aneurysm repairs, iliac and femoral stenting, thrombectomies, and etc. We have done these succesfully with various techniques, and I was curious about applying your MIA technqiue to this group of patients as I didn't see vascular surgery listed in your book as a typical surgery one would consider MIA on.

So far this week, I have used it as written on 4 separate patients, and am currently writing you from the head of the OR table where I am doing a 63 y/oM ASA3, mod COPD, h/o MI x 2 with angioplasty, having a aortofemoral graft distal reconstruction and fem/pop bypass thrombectomy.

The technique is working rather well with the exception of some very occasional light patient movement with BIS 65, 3 local injections on the field and 75mg ketamine.

Most impressively, the hemodynamics are incredibly stable. My first patient with a AAA and iliac aneurysm repair this AM did have a brief laryngospasm 2 minutes after ketamine after a distinct coughing episode. Thanks to your recommendations, I was able to quickly break the spasm with an 2mg/kg bolus of lidocaine and the remainder of the case was flawless.

The patients have all been awake quickly without post-op pain medication required. Besides starting the propofol a bit slower and sometimes with a lower starting infusion rate, I have essentially applied the protocol as written without much deviation even on this quite different patient population.

I have shared this technique with our surgeons after they have seen how well the (admittedly few so far) patients have done, and they are quite pleased, as are the staff anesthesiologists I have worked with so far who have allowed me to use this technique.

Thanks!

"Dr. Friedberg's long-standing vision, innovation, and tireless devotion to the practice of cosmetic surgery anesthesia is efficient and thoughtful, while providing for a practical, outcomes-directed approach to office-based
cosmetic surgery anesthesia. The sticking point for many patients is the post-surgical experience of nausea and vomiting (PONV). Dr. Friedberg's PK
technique, which is applicable to a variety of elective cosmetic surgical procedures, reduces this uncomfortable byproduct of an otherwise
positive surgical outcome. As more consumers know about this option,
elective cosmetic procedures may be more widely and easily embraced."

"Dr. Friedberg's PK technique has worked wonders for my patients. They awaken from anesthesia with a very happy affect, frequently reporting an enjoyable experience! This is what distinguishes PK from other anesthesia techniques. Furthermore, the paucity of nausea, hallucinations, or delayed discharge has made the technique an invaluable component of my armamentum. Dr. Friedberg deserves all the accolades for enlightening our company. His zeal to educate colleagues and patients is unmatched."

Dear Barry,

I am deeply impressed with your carefully researched letter to Dr. Gupta. Instead of obfuscating ketamine's merits as some "experts" have in recent past, you have published in peer reviewed journals and thereby have provided us with an empirical basis to move forward with exciting new applications for this old drug. In addition, the presentation of your research before state anesthesiology societies, such as ours in Florida, has been a great benefit to our profession. I hope that people like Dr. Gupta will not become a member of that crowd who fail to understand that clinical science can and has been advanced by people like you.

The tide of history is at times slow for us humans human beings, but it moves nonetheless. More and more anesthesiologists are growing uncomfortable with the view about your work expressed by people like Dr. Gupta.

Once again, I commend you for your important contribution consonant with the highest principles of our profession.

"Dr. Barry Friedberg has revolutionized my anesthesia service. We have performed over 100 abdominoplasties under propofol ketamine anesthesia. The patients are extremely happy with his anesthesia. They feel great upon awakening and have almost no nausea or vomiting. Wow, what a difference it makes!!!"

"Friedberg is a respected anesthesiologist, frequently cited for spearheading the innovation of PK to tame the negative effects of cosmetic surgery anesthesia. His deep sense of commitment to patients and the surgeons he works with is globally known, and his selfless efforts to educate both populations is a tribute to the field of medicine, surgery, and anesthesia."

Dear Barry,

It was a great pleasure meeting you in California recently, on the occasion of the endoscopic seminar. Your anesthesia techniques are superb and your chapter in the anesthesia textbook for head and neck, as well as oral surgery is very clear and most informative.

Again, thank you for everything. I learned a great deal talking to you and watching you provide anesthesia.

Very sincerely,

Dear Dr. Friedberg,

I first learned of this propofol ketamine (PK) technique several years ago when I posted the dilemma of patients of a certain cosmetic surgeon with whom I worked. This colleague attributed his post-op problems (facial hematomas and wound dehiscences) to anesthetic techniques.... namely relatively low BP intraop with subsequent BP rise on emergence and extubation causing bleeding as well as straining on extubation causing wound suture dispuption.

Before trying it out, I obtained printed literature on this method after Dr. Friedberg suggested his technique. I have had very good results. The cosmetic surgeon now attributes his suboptimal outcomes on less-than-ideal O.R. equipment as well as patient factors. However, the patients awaken quickly post-op, often amazed to find out everything was completed and that two or three hours had elapsed. Recovery and day surgery nurses also were impressed.

There is a bit of puzzlement how to class the anesthetic...whether “neurolept” or “general”. I tell them check off “general”, since the patient is non-rousable while the Propofol drip is running, although without local anesthetic it may not have worked as impressively. As it turns out, the cosmetic surgeon for whose patients I first began to use this technique hasn’t booked many cases suitable to this technique in the intervening years. Nonetheless, I’ve adapted the method to a variety of other procedures much more frequently performed at my home hospital.

1. Morbidly obese patients. No....not for the gastroplasty and/or bypass, but for some minor procedures occasionally done post-op before the patients begin to lose much weight. In the laparoscopically banded procedures occasionally the injection port needs to be re-sutured or alternatively adjusted. In open procedures, wounds occasionally get superficial infection. The surgeons have tried local only but quickly gave it up. The PK method is ideal...maintenance of spontaneous breathing and airway (O.K. a bit of mandibular support on occasion), good surface analgesia and immobility for the surgeon. Many of these patients have awoken reporting a feeling of euphoria and well-being.

2. Hemorrhoid surgery in prone position. A new surgeon learned this in residency...better exposure and less bleeding than supine-lithotomy or lateral positions...and it’s caught on with other general surgeons. Where she trained, the anesthetists have boluses of fentanyl and midazolam. I was already comfortable with PK so used this, letting the patient self-position while awake, then titrating to sleep with propofol and giving ketamine just before the local. Patient awaken prone and obligingly turns onto side on the recovery room gurney parked next to the OR table. Works equally well for pilonidal cyst excisions. I find these patients are often obese, sedentary types and I’m glad not to have to intubate and then flip over (and later back) 100+ Kg. of dead weight and flopping appendages.

3. Many superficial procedures where muscle relaxant isn’t needed and local can be infiltrated. Many breast excision biopsies and simple hernia repairs fall into this category. If it’s not sufficient, then it’s no big deal to switch to inhalational anesthetic and insert LMA or even inject a reduced propofol dose and intubate.

4. I’ve begun to do knee arthroscopies by this method. One orthopod needed reassurance that he could proceed when he saw a patient lying there without a tube or LMA in the mouth breathing room air and when I told him that it WASN’T a spinal.

   Anesthetic colleagues also ask whether my patients don’t emerge dysphoric or delirious from ketamine, a drug they regard as akin to L.S.D. I explain that it can happen when ketamine is used “solo” in large doses (even then not that often or severely), but as a dissociative agent given to an already unconscious patient, it’s a non-issue. I remind some of them that they routinely reverse each and every patient...generally employing neostigmine and atropine...a far worse culprit in producing delirium.

5. I had an ortho list yesterday.... total knee and then several ganglia, a carpal tunnel and some knee ‘scopes. The first case was spinal, the rest were PK with local by the surgeon. Supplemental O2 was required neither post-op nor for that matter intraop in any of these patients. Hate to say there are still lots of colleagues around who’d have intubated and ventilated each of these patients, likely lugging some of them into recovery room still intubated. Sore throats, achy muscles, several extra hours of recovery time and nursing hours, perhaps even an unscheduled overnight admission, even if worse problems such as traumatic intubations or bobbled extubations followed by laryngospasm and negative-pressure edema didn’t occur.

Barry,

I've been using propofol with ketamine for 4-5 years now. Initially I mixed them in the same syringe, but about a year ago I started using 25-50 mg ketamine boluses separately. It works great as a supplement to MAC for breast biopsies and hernia repairs. I also use it for a laundry list of procedures that do not lend themselves to "conventional" MAC, things like closed reductions, lithotripsy, debridements. I used it last week on a woman who dislocated her jaw and had her mouth jammed open. Also used it last week for an open ankle reduction on an anticoagulated patient with a fresh MI (his heart rate and blood pressure never changed from baseline). It is the answer to every anesthesia question. Many of the surgeons now request the technique. None of the patients has had any complaint; although some have noted particularly pleasant experiences.

February 22, 2008

Dr. Friedberg,

I seriously believe that you were sent by God to do your job on this earth. God bless you!

I have had numerous cosmetic surgeries over the years all with horrible outcomes because of the anesthesia that was administered to me. I was continuously overdosed and when I tried to relate this to the surgeons they would then under dose me. I woke up during the operation! No one could ever get it right until you came along.

With you and your SIS monitor, 7 years ago I woke up after a 10 hour procedure and simply felt like I had been to a cocktail party, other than the fact that at that time you had depended on the surgeon to administer the pain medication which he did very apathetically.

Since that time you have perfected your technique. The surgery that I just had with you doing the "MIA" was the most excellent yet, especially since you were the one that provided everything that I needed.

I now refer you as "my anesthesiologist" and I go "under the knife" with little or no fear knowing that you are there with me.

Thank you so much Dr. Friedberg. I do believe that you are a saint.

Always,

June 20, 2006

Dear Dr. Friedberg, Thank you for taking such good care of me during my surgical procedure on June 8^th. I feel so grateful that, after inquiring, I was informed that there was, in fact, a less invasive form of anesthesia available.

As you know, I was hoping that this method would circumvent my getting a migraine headache after the surgery. This did not happen. I did get the headache later that evening, but it wasn't any worse than the average migraine I usually get, and was successfully treated with the Imitrex.^®

Nevertheless, the more impressive part was how incredibly great I felt immediately after surgery, as well as on the following days during my recovery period. I was very alert, feeling very little pain, quite stable on my feet, and reasonably strong and comfortable. I know from personal experience, that after general anesthesia, I never felt that good.

The total experience of being under anesthesia, from start to finish, was amazingly easy; and, I attribute all of that, of course, to your expertise! I was 100% confident that I could not have been in any better hands than yours, and that your less invasive method of anesthesia clearly was, for me, the way to go. I'm very sure that it would also be a better option for many others who are not even aware that your methods exist. Keep spreading the word, as it is clearly a great option for anyone who wishes to recover from the effects of anesthesia more comfortably and quickly.

Thank you so very much for everything!

Dear Dr. Friedberg,

I just wanted to thank you for the wonderful morning we spent together last Tuesday, June 15th. Granted, our date was spent at the operation table at Dr. C's office, but what an experience!!!!! The last words I remember from you were Pina Colada, and one second later I heard my daughter say, "Mom, how do you feel?" I remember immediately opening my eyes, sitting up, and wondering when my surgery was going to begin. I was truly blown away when I was told I could go right home. I didn't have to stay for two hours in which to recover?!?!? If it weren't for insurance purposes, I could have walked to the elevator and to the car all by myself without the wheelchair.

I felt so good, no "hang over" or nausea, or even feeling like I needed to go straight to bed. When I got home and started calling everyone, they were all amazed by the sound of my voice, as they thought I would be drugged and just wanting to be left alone. I just don't think there are words to thank you enough for going the distance for your patients and getting us out of the Stone Age where we were over drugged and sick for hours after surgery. It makes such a great difference in our recovery.

You and Dr. C make such a grand team and I'm so blessed to have found you two. If during the day you feel your ears burning, its because I'm bragging about you and letting everyone I know about your PK technique. You are truly an amazing doctor and I am very thankful for doctors like you. By the way, I did see the colors, but it seemed like just for a blink of an eye! Again, thank you for making this surgery such an extraordinary experience.

Always,

Dear Dr. Friedberg,

You have been my anesthesiologist in all 5 of my cosmetic procedures. After each one, I have awakened totally alert, with no headache, no nausea, and the ability to think 100% clearly. Each time, I have used Tylenol only on the first night, and never anything after that. How amazing! Your years of working towards perfecting PK have really been worthwhile. Thank you for seeking the very best. I am reaping the rewards!

Dear Dr. Friedberg,

I just wanted to write a letter to tell you how impressed I was with the level of professionalism and courteousness I received from you during my surgery. I would never have expected to feel so respected and appreciated during any type of operation. I have had seven surgeries in my life that have required anesthesia and none of my other experiences were at all pleasant. In fact, the most unpleasant part of my surgery experiences were the harsh and unfriendliness of the staff inserting my IV's and administering my medication. I was very pleased with the level of attention and care I received and appreciated the way you explained everything to me step by step so that I would know what to expect. I will definitely request to have you as my anesthesiologist for any of my future needs and would recommend you to other patients. Feel free to use me as a reference for your future patients.

Thank you again, from the bottom of my heart, for making my experience
enjoyable.

Sincerely,

Dr. Friedberg,

For some time I've been meaning to send you a note thanking you for being my anesthesiologist on May 1st of this year.

My cosmetic surgeon was performing some touch-up surgery and I wasn't looking forward to the anesthesia because of a previous experience. I vomited for two days, and my hand was swollen and bruised from the IV. My surgeon assured me it wouldn't happen with you as my anesthesiologist, and he was absolutely right.

The medication given to me prior to going into surgery was wonderful; I was completely relaxed going into the OR. In the OR, the combination of drugs you used, and your method of administering them slowly, and as necessary, instead of "knocking me out with a hammer” worked just as you said. I awoke easily, without any nausea. In fact, I remember my first thought was to ask the nurse to thank you!

I can't tell you how much I appreciate you. I was pleased with the experience. Thank you again.

Dr. Friedberg:

Thank you for the great anesthesia on my daughter, Christina, on 5/14/02. We both appreciate your expertise.

Nice website, also.

I have been using your 'Less Invasive' anaesthesia technique for the last one year. This is my routine technique for all my orthopaedic surgery work in private practice.

Instead of the local infiltration, I administer a nerve block/ continuous nerve block infusion after giving ketamine. It works amazingly well.

I believe the full benefits of regional anaesthesia is not captured by anaesthetists who continuing to administer a conventional general anaesthesia.

The full potential (of PK anesthesia) is realised by combining regional anaesthesia with PK anaesthesia.
 

July 14, 2009

Dear Dr. Friedberg,

I read your book and [it] totally changed my everyday practice.

I managed to do [everything] from open cholecystectomy (with a paravertebral block) to aortic aneurysm.

When the surgeons place an intra-aortic stent and [I] personally [use either an] inguinal field block or bilateral paravertebral with your technique.

It was the "silver bullet" - as you say in a part of your book - that I was trying to find.

Again, thank you so much!

In response to her question, 'Do I have a financial relationship to brain monitor makers?'

Answer: Neither I nor the non-profit Goldilocks Anesthesia Foundation have any financial relationship with either drug or brain monitor makers.

Her response:

So many times it appears for financial gain that people push a product such as the brain monitor, so I apologize, but I had to ask. I enjoy your articles and am a fan. I work for cosmetic surgeons so your work is of special interest to us.

Beginning 1 August, I will be the President of the Virginia Association of Nurse Anesthetists serving over 1100 members. We have a publication which we produce quarterly in which we like to include articles from which our members can benefit. I have always found your articles to be both interesting and applicable. Would you be opposed to my including your posts from time to time? You would of course receive full acknowledgement.

Thank you so much for your dedication to the safety of anesthesia!

Respectfully,

Jan Setnor, CRNA, MSN

P.S. By the way, I'm a Californian as well! My husband was in the Air Force and we had so many assignments to Virginia my kids think this is home. Thank you again, Jan

Hello Ladies,

Hope all is well. Just wanted to let you know that I had a real treat to watch the famous Dr. Barry Friedberg in action with his method of procedural sedation a few weeks ago. It was amazing. After the tummy tuck, the patient walked herself to the restroom after surgery. No vomiting or nausea. She was smiling. I am having him take care of me on my next tummy tuck :)

Although the economy is not at its best for our patients, Dr. Friedberg's rate is very reasonable compared to most dental anesthetists out there, and he is a medical anesthesiologist, M.D. He will be presenting lectures in the near future locally. I will keep you posted.

He is very professional, easy to talk to and a great teacher. He is my new mentor to say the least. Let me know if you ladies have a break to meet him or see him in action.

He would be a great for your future surgeries. Who wants to work on squeamish patients just under local anesthetic anyways.

He has written over 60 publications. The latest one, Getting Over Going Under, is great for patients to read. Let me know if you would like one and I will let him know. He won't sell them to you. He will give it to you and only ask you to donate to his non-profit Goldilocks Anesthesia Foundation.

Talk to you all soon!

P.S. Please forward this email to the other dentist friends I do not have emails of who are among our circle of lady dentists. Thanks!

Looking forward to our next get together ladies!

Dr. Friedberg,

I second Dr Rodriguez.

I started using your anesthesia technique in 2006, and in concert with my rapid recovery breast augmentation procedure, after more than 1400 cases, I have never had a single DVT, PE, or any other significant complication.

It had been a struggle finding the right anesthesia providers, but I found some that were very open to trying, and now they use this technique at their other surgical offices, most of the time unbeknownst to the surgeons!

When I do back-to-back-to-back breast augmentations, I NEVER have more than one person in recovery. They are all awake, alert, eating, drinking, smiling, and best of all, without pain!! They rave about what we do, and I credit this in large part to the anesthesia that Dr Friedberg has described.

Thank you, very much.

The practice of medicine requires a lifetime commitment to learning and flexibilty to provide the best care for our patients. Unfortunately, the practice of plastic surgery tends to be inflexible and focused on the use of general anesthesia which in my opinion is more for the surgeon's convenience rather than the patient's in many cases.

As it has been my focus to perform natural aesthetic procedures which are safe, under local anesthesia with light sedation and with a quicker recovery. Dr. Friedberg's contribution to my practice through his experience is truly appreciated.

05/31/12 10:26 PM
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Dear Dr Friedberg,

I am every anesthesiologist's nightmare: A plastic surgeon who has read, understands and believes in your book!

I just got off the phone with a patient I performed an abdominoplasty on, and she was annoyed that I woke her from a restful sleep at home without medication.

It is a tough 'sell" to your stubborn colleagues, but well worth it.

Thank you for your great work,

Barry,

I thought your course was great. The concept makes perfect sense.

It should be no surprise to you that the biggest problem for me is getting my anesthesiologists to try it. Two have and the results were great. No nausea, no pain and overall a good feeling about their surgery. These were 2-3 hour cases and many of mine are 5-7 hours and one of the problems we have now is getting enough P and K.

Also, the longer cases are the difficult ones for me to get buy-in from the anesthesiologists. I am going to continue to try (the younger docs are more willing) and over time I think I could have enough experience with the technique that I could endorse.

Thanks for agreeing to present at our meeting. You can, of course, mention that I have been so impressed with the technique that I asked you to join the faculty for the 2014 AAFPRS course.

Warm Regards,

Dear Dr. Friedberg,

Two weeks ago I was telling my friend Patricia Bacall that I was going in for lumbar surgery and how reluctant I was to have the operation done because on the horrendous experience I had from being overdosed with anesthetic the last time I had surgery. I said the worst part of the whole experience for me by far was the weeks it took to get the excess gas out of my system and how horrible it made me feel--I thought I would never get my mind and my lungs back.

Patricia then told me excitedly about a book she had helped design a couple of years ago by a doctor named Barry Friedberg. She gave me a summary of what it was about and urged me to buy it. I'm so glad I did. Getting Over Going Under turned out to be the best investment I ever made.

I read your book hurriedly--my surgery was in three days and I was desperate. The key points you made were real eye-openers. I called my neurosurgeon's nurse and, to my relief, learned that the Community Hospital of Anaconda, Montana did in fact have a Brain Activity Monitor. The nurse was a little baffled at my instance on the monitor, but faithfully relayed my request to the nurse anesthetist (Anaconda doesn't use anesthesiologists) assigned to my case.

I arrived the morning of my surgery to learn that I had been assigned a different anesthetist, Robin, and that Robin had not received word of my request. We had a long talk as they were getting me ready for surgery. I told her of being overdosed with anesthetic the last time and the horrible experience I had getting over it. I told her I didn't think I needed as much anesthetic as most other people. Robin listened carefully and said yes, she would use a brain activity monitor if that's what I wanted. If that's what I wanted! She was as good, experienced, caring and competent as they come...but if I had not requested the monitor she would not have used it!

It was a long, tedious, four-hour surgery. Robin visited me that afternoon and again the next morning after my head had cleared. I had no hangover and no side effects from the anesthetic and was anxious to hear what had happened. Robin said she was amazed at what little anesthetic I had needed. She said during surgery that my blood pressure remained constantly low and normal--that it didn't spike with pain.

She said that normally the blood pressure readings would have clued her that less anesthetic was necessary, but without the brain activity monitor she a) would have had no way of confirming it, b) not have had the confidence to keep me under with such a low doses of anesthetic and c) not known exactly how much to give me. I don't know who was more thrilled and amazed, me or her. It has now been ten days since my surgery and not once have I felt any ill effects from the anesthetic. The difference between this operation and the last one is night and day...all thanks to you!

Dr. Peter Sorini performed a brilliant surgery and got me out of nerve pain, but had it not been for your book, Getting Over Going Under--had you not dedicated yourself to trying to alert patients and the medical community at large to the common medical practice of overdosing patients with anesthetic--the wonderful recovery I am experiencing would instead be a living hell.

Thank you for your book, for your courage and integrity in the face of medicine's often-stubborn resistance to new ideas and information, and thank you for using graphic designer Patricia Bacall on your book...or I would not today be enjoying the miracle of not having been poisoned half-to-death with anesthetic.

S.G.M.

I had revision surgery about a month and a half ago with you as my anesthesiologist. I know this is a little late, but I wanted to thank you again for making the entire procedure effortless. For taking the time, step-by-step, to go over the procedure, methods and reasoning, to truly care if i had concerns, thank you. For making the whole experience free of unpleasant nausea and sickness, thank you. Most of all, thank you for inspiring my awareness, my experience with you is a tool I can use to protect myself the rest of my life, and I appreciate it deeply.

Best of Luck and Continued Success,

Dear Dr Friedberg,

I wish to thank you for your help and suggestions given to my dear friend Magda S on my behalf concerning a surgery preformed on me earlier this morning. I was terrified that something would go wrong during anesthesia. She gave me your book, 'Getting Over Going Under.'

Friday evening after I had been suddenly and unexpectedly informed that I would have Monday morning surgery. Because of the weekend, there was no way to find and contact routine anesthesia over this time..

I took your book with me to the hospital and just happened to be reading in my preop bed at the moment my anesthesiologist arrived to speak with me before the actual procedure.

I asked him to use a brain monitor. He wanted to know why and I elaborated upon my own previous nursing observations and a similar event described in your book that happened to my husband. He shook his head indicating that my reasoning was agreeable and supported to my request. I then broached the subject of and Diprovan and mention 'brain wind up syndrome.' All the while he shook his head in agreement and then took the book from me perusing it for several minutes. He stated he was aware of much of the information but had never seen that particular book. He appeared genuinely interested and pleased. His manner turned quite kind and he smiled saying "No problem, I give you want you want and will be very sure to take great care with you."

I awoke shortly after surgery, bright and fully alert. I was in the recovery room less than thirty minutes, stood on my own with no wooziness and dressed without assistance. I was also the first of those in the recovery room at the same time ready to be discharged!

I lay here on my bed on my stomach as I write to you with no breast nipple pain at the I&D area whatsoever. With my last breast surgery, I would have chomped at least four or more Vicodan by now sound asleep or moaning. I have no hangover or nausea. I had a hearty dinner which is extremely unusual for me after surgery, as I am indeed a veteran (ten major as of today). I also know that I did not need to have intubation for the first time under general. At present and am just emotionally fatigued from the general ordeal. I made all of my own calls to my friends and family to let them know I am well and everything went along fine with the surgery. My husband usually has to make those calls! He actually forced me to rest most of the day as I would have rather been up taking care of business as usual!

I thank you again for your care and efforts on behalf of all surgical patients. You work has allowed me to have some control and autonomy during a fearful time when many in that position are at their most helpless and vulnerable.

With utmost sincerity,