Search
Testimonials
Dear Dr. Friedberg:
I just finished your wonderful book Anesthesia for Cosmetic Surgery. What a revelation. I have been using benzodiazepines and ketamine for 30 years for nearly all of my elective aesthetic plastic surgery cases and for many hand and trauma cases. During this time, I have never had a deep vein thrombosis, a pulmonary embolism, a positive pressure, a pneumothorax, a negative pressure pulmonary edema, a flash pulmonary edema, a chipped tooth, an injured vocal cord, a fire or explosion in the operating room or damage to the trachea of a patient, intractable postoperative nausea and vomiting, an awake but paralyzed surgical patient, aspiration, or litigation involving anesthesia. Recent teaching courses and patient safety continuing medical education (CMA) requirements in plastic surgery have focused on the prevention of deep vein thrombosis and postoperative nausea and vomiting. These are complications not of minimally invasive surgery but of maximally invasive general anesthesia.
When I have suggested to my colleagues that all cosmetic surgery can be performed safely, simply with IV sedation, they are reluctant to try because they are accustomed to having an anesthesiologist monitor the level of sedation and are concerned that clinical impressions are not adequate. Your book that clearly describes the use of propofol and the BIS monitor solves their dilemma. Studies have shown that incidents of deep vein thrombosis, subsequent pulmonary edema increases with every hour of general anesthesia. Universal acceptance of your principles of intravenous sedation for minimally invasive anesthesia for minimally invasive surgeries can save thousands of innocent lives each year.
Robert A. Ersek, M.D., F.A.C.S.
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.
C. Philip Larson, Jr., MD
Chaiman of the Deparment of Anesthesia at
Stanford University during Doctor Friedberg's
training from 1975 to 1977.
August 23, 2008
Dr. Friedberg:
I just wanted to thank you and say how happy I am with my anesthesia experience on 8/11/2008. I had a breast lift and abdominoplasty, and we spoke beforehand. I told you how I work in veterinary dentistry and induce/maintain general anesthesia in animals.
For the first time in my life I didn't wake up retching with nausea after anesthesia. This would probably be the most important time as well as my abdominal muscles were very painful from the procedure. I woke having wonderful dreams (of eating lovely golden fried chicken!) and started talking to the operating staff coherently feeling pretty much 'normal.' I ate a normal dinner that night as opposed to my usual experience; typically it's more than 24 hours before I feel like eating, surely taxing my healing processes.
Your technique did make a drastic difference for me and my recovery, and should be adopted by anesthesiologists readily. I cannot state enough what a difference you had for me, and my great thanks to you.
Thank you again,
G.S.
"Dr. Barry Friedberg - Cosmetic Surgery Anesthesia - Propofol Ketamine is my primary technique for almost all office based anesthesia cases including facelifts, eyelifts, laser skin resurfacing,
liposuction, rhinoplasty(closed), and frankly any other case that is superficial... Another advantage of this technique is the low incidence of post operative nausea and vomiting (PONV).
Marshall M. Garland, MD
Assistant Professor of Anesthesiology
NYU Medical Center
New York, NY
"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."
David Mayer, MD
Board Certified Anesthesiologist
President, Esurg Corporation
Medical and Pharmaceutical Supply Company
Seattle, WA
dmayer1@uic.edu
www.esurg.com
"Well indeed, I had to see it to believe it, my last 15 cases where I have used your technique, no narcotics, and they have done well! It is also so enjoyable to see them awake and be so happy. Not even a hint of nausea and vomiting. Fantastic."
Frank Kunkel, MD
Private Practice Anesthesiologist
Pittsburgh, PA
Fak9717@hotmail.com
"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."
Marc Koch, MD, MBA
President and CEO
Somnia, Inc.
New Rochelle, NY
www.somniaanesthesiaservices.com
"Dr. Friedberg is a wizard at providing anesthesia for patients undergoing
cosmetic surgery. His propofol-ketamine technique has revolutionized the
field. His patients receive an excellent depth of anesthesia yet rarely
suffer from postoperative nausea or vomiting. Dr. Friedberg has taken the
field of office based anesthesia to a new high level of patient care. His
work is amazing, and I'm glad he has begun to publish his findings."
Charles E. Laurito, MD
Professor of Anesthesiology
and of Anatomy and Cell Biology
Director, Pain Management Program
Chicago, IL
President, Society for Office Based Anesthesia
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.
Anthony Kirkpatrick, M.D., Ph.D.
akirkpat@hsc.usf.edu
"Yesterday I anaesthetized a 54 year old for mastectomy and tissue expander. Always sick after anesthesia, she was anaesthetized about 2 weeks ago whilst I was on holiday, and the anesthetist made bold efforts to prevent the heaving by adding in metoclopramide, and ondansetron during the anesthetic. She woke up and immediately felt sick. She was administered cyclizine (an antihistamine type anti-emetic) and immediately developed a kind of locked in syndrome. So not only did she continue to feel sick, but she had the terrifying experience of not being able to move.
Yesterday she was extremely apprehensive about a further anesthetic. I gave her the PK "its anesthesia Jim, but not as we know it". She woke up, pain free, nausea free and laughing. Many thanks again."
Chris G. Pollock MB ChB
madgas@poloks2.karoo.co.uk
Consultant in Anaesthesia and Pain Medicine
Castlehill Hospital
Hull , UK
"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!!!"
Nikolas V. Chugay, D.O.
Internationally recognized aesthetic plastic surgeon
Developer of buttock, bicep and tricep augmentation
www.drchugay.com
"Barry Friedberg invented and popularized our techniques and does it in a more sophisticated fashion. The following is especially modified for liposuction.....PK technique: Safe, very little respiratory depression and NO post operative nausea or vomiting. Propofol (soporific only; short acting, anti-nausea) drip to sedate, then 50 mg of ketamine (dissociative anesthetic: salivation, great but brief analgesia, blood pressure elevation, short acting) slow IV push (watch for respiratory depression carefully for a few minutes) and two minutes later, pump in tumescent as rapidly as possible with your peristaltic pump. This is a very small dose of ketamine, and with this dose, the dysphoria that the anesthesiologists object to virtually doesn’t occur. Robinul (drying agent) 0.2 mg (1 cc) given IV at the start of the case; usually prevents salivation and occasional respiratory problems that occur occasionally with Ketamine."
Robert Yoho, MD
"Yoho Method” liposuction anesthesia technique ABCS board certified in cosmetic surgery a ABMS board certified in emergency medicine
www.dryoho.com
"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."
Nicanor G. Isse, MD
Internationally recognized plastic surgeon
Specialist in Scarless and Minimal Incision Surgery
Director of Isse Institute for Cosmetic Surgery
Los Angeles, CA
drisse@iconoplasty.com
www.iconoplasty.com
Hi! I am a CRNA in Louisiana interested in learning your PK technique. I am employed by 5 plastic surgeons and 2 of which trained at Stanford (these both state that propofol was the main anesthetic used there). I am willing to learn, but they have a hard time realizing that the patients may move at times. I did a blepharoplasty that went well with a propofol drip and the patient was real happy. Of course, I trained 23 years ago and was always told that ketamine gives the nightmares. At what BIS reading do you find that it is ok to give the ketamine? Does this last for the duration of the local if the doc takes 5-6 hours? Let me know I will download your articles at work and read them.
Thanks, Leslie
---------------------------------
Leslie,
Thank you very much for your interest in PK.
Doing PK MAC* is much more an attitude than an aptitude. You already possess 1,000X the talent to do PK. It's very simple and it works. Picture yourself removed from the 'analgesia' business and posture yourself as a propofol hypnotist (99%). The dissociative dose of ketamine(1%) creates the window of opportunity in which to inject the local without hurting the patient. Good local is the key.
Hypnosis first, then dissociation is the other key. Without the BIS, hypnosis is loss of lid reflex and loss of verbal response before dosing with the ketamine. With the BIS, it's 70-75 before ketamine. Also, when the patient moves at BIS = 60-70, they must realize more lidocaine not propofol is the correct response. All of my surgeons are now trained to ask what the BIS is when the patient moves.
Ketamine is not a fentanyl substitute. Once the local is injected there is no reason to persist in giving more ketamine. I logged 2,680 PK cases in ten years. Surveying my last 500 cases, 40% were done with a single 50 mg bolus of ketamine, 40% were done with two 50 mg boluses, and only 20% required additional ketamine. Do not exceed an aggregate of 200 mg ketamine in any case and absolutely none in the last 20 min....and does this last for the duration of the local if the doc takes 5-6 hours?
The length of case is irrelevant as is the patient weight. The small portion of the midbrain and spinal cord containing the NMDA receptors does not vary appreciably in adults, so 50 mg works pretty darn well (95-98%) of the time. I cut back to 25 for Asian born Asian patients. Also, 25 mg will get you about an 80% response rate in gringos. Too tedious for me.
As a point of curiosity, did your surgeons express an interest in PK or did you suggest it to them? I am curious because I want to know what the force for change in your interest was? Did you see one of my ads celebrating 10 years of better anesthesia?
The web site was created to inform patients about PONV free anesthesia in PK and to ask for it!
Please keep me posted on your experiences if you can. I am always interested in feedback from my 'disciples.'
Most of my 5 articles are on the web site under 'Published Articles.'
Yours for better ( & reproducible) outcomes,
Barry L. Friedberg, M.D.
---------------------------------
P.S.
Look for 2003 International Anesthesiology Clinics Vols I & III for my two chapters on PK including 'the cookbook.' I'll be at the Lippincott booth at 2003 IARS, SAMBA, ASA, & PGA to autograph copies. Hopefully, one will be for you. I don't receive royalties or any other form of remuneration. Just trying to promote PK. Tell your friends. Tell your surgeons that one of my main clients is Nicanor Isse & watch their eyes get big with recognition. Isse pioneered endoscopic browlift in '92, ironically the same year I pioneered PK. Took us minimalists a while to find each other. :-) He does minimally invasive cosmetic surgery & I do minimally invasive anesthesia®.
*PK MAC is derived from Vinnik's diazepam ketamine technique, published 1981 in PRS. PK TIVA wherein the two are mixed together is derived from Guit 1991 Anaesthesia. Mixing involves two hazards - 1) one may not achieve the all-or-nothing threshold of dissociative effect (i.e. patient does not move for local injection) & 2) more likely to exceed the 200 mg aggregate dose of ketamine producing an unsatisfactory emergence.
Leslie
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,
F. Don Parsa, M.D., F.A.C.S
Professor of Surgery (Plastic)
University of Hawaii
The John A. Burns School of Medicine
Chief of Plastic Surgery Division – The Queen’s Medical Center
Barry,
Just a quick line to let you know that the residents, and other faculty, have been impressed with PK. Recently, I used PK for an ASA IV patient. He was a 60+ year old w/IDDM and just several days "out" from a severe acute AWMI. His EF was < 20%. The patient required an emergent BKA.
I did the case, with a resident, with a combined anterior sciatic block and femoral block. PK worked just fine. The residents (anesthesia and surgical) were amazed. So was the vascular surgeon.
In addition, PK worked extremely well, as a supplement, to an axillary block for a renal failure patient. The patient needed the usual AV graft for dialysis access. He was awake and ready for d/c almost as soon as the "stuff" was shut off.
Glen Atlas, M.D., M.Sc.
hga@earthlink.net
Associate Professor of Anesthesia
New Jersey College of Medicine and Dentistry
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.
-
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.
-
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.
-
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.
-
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. - 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.
Alan Tallmeister, MD
Unionville
Ontario, Canada
Email
Dear Barry,
Just a quick note to say hello again and to let you know of my latest exploits with PKRASV. I had a case some time ago of an elderly lady who was a pulmonary cripple for segmental mastectomy. Did her under PKRASV, worked great. Wrote the case report and it was accepted for publication in American Journal of Anesthesiology- but the journal just folded before it could be printed! I was just a little too late, I guess.
Anyway, I did another case today for colonoscopy. The GI doc called me to do the case because she had "failed" under prior sedation regimens by non-anesthesiologists. A little ketamine and propofol, and next thing I knew, the case was done, the patient was laughing and joking, and the GI doc was in my gratitude. It's nice to have a tool that works so well!
Thanks, and keep it up-
Skip Culp
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.
Steven Schrenzel MD
Media, PA
Email
Dear Barry,
Just a follow up. We have performed well over 1000 anesthetics for out patient neurosurgery cases using a modification of the PK in the last 11 months. No admissions, VERY infrequent nausea and only one episode of vomiting. (this in a diabetic with severe gastroparesis and regurg preop) We do modify your described anesthetic protocol using "BKK" infiltrated prior to and with closing the incision, and have come up with additional "tricks" using inexpensive old reliable off patent agents. BKK is .25% marcaine with epi (1:400,000,ketolorac0.1mg/cc,ketamine0.5mg/cc) Typically our patients verbal pain scores are 4 to 5 with in 3 minutes of extubation. Load po hydrocodone 10 to 20 mg as soon as swallowing safely. 90 to 95% of our patients bypass level one recovery. Our patients are fully ambulatory, void, and tolerate po fluids prior to home discharge. Average pain score 1 to 2, never discharged with a score higher than 5 by protocol. Our "record" d/c time post extubation is 47 minutes male, 43 minutes female.
Our propofol and inhalational agent costs are incredibly low. In addition very infrequent antiemetic need relates to lower total formulary and fluid costs, not to mention the staffing costs. Our turn over times average 3 to 4 minutes. Our surgeons are very happy and tired of the patients commenting "how wonderful we are". The only complaint from our staff has been lack of over time (1.5 x standard pay). I am crunching the numbers for our lumbar lam, posterior cervical lam, and anterior cervical lam/fusion patients and hope to have some meaningful hard data soon. Your thoughts on where to submit for publication?
Brad Worthington
Email
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,
J.G.
April 17, 2007
Hi Dr.Friedberg,
I just wanted to say thank you so much for your wonderfull work during my surgery on April 5th. You were right, going to sleep was the best part of it all, not to mention my nice dreams of going to the spa. The only bad part was that i was about to get a massage right before you woke me up :-). (well maybe next time LOL)
I was scared that I would get sick after the anestesia but when i woke up I felt just like after a good night's sleep.
If I ever need to go under anesthesia again, I will definitely request you doc. and recomend you to everyone I know.
Thank you for holding my hand too :-)
Sincerely,
Florentina
Ciao!
June 20, 2006
Dear Dr. Friedberg, Thank you for taking such good care of me during my surgical procedure on June 8th. 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!
L.P.
Dear Dr. Friedberg,
I just wanted to tell you how much you and your anesthesia technique MIA® changed the outcome of my breast revision surgery. Having had six previous surgeries on my breasts, like it or not, I have become an expert on anesthesia! The total experience with your technique was wonderful, making an invasive surgery experience almost pleasant. The drugs given to me before surgery, took away all my anxiety and your compassion and attention made the transition to “sleep” calming and enjoyable rather than “scary” as in my previous experiences. Upon awakening I felt like I had a good nights sleep and was ready to get up. I helped move myself to the gurney and off to the recovery room. I am now feeling very well chatting with the recovery nurse. She tells me I am the first patient she has ever had a conversation with. It is also the first experience for me having any recollection of the recovery room. I have absolutely no nausea. And home I go armed with a collection of pain pills and muscle relaxers. But to my surprise I have no need for either drug. I had my post op visit the next day. Everyone remarked that I didn’t look like I had surgery. I didn’t feel like it either. No pain, no nausea and no anesthesia hangover! (This in previous surgeries lasted for weeks). I felt so well, I had to really focus on taking it easy.
Thank you for your wonderful anesthesia. I will most likely have cosmetic surgery again, but not without you…..
S.B.
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,
C P
Dr. Friedberg,
I just wanted to say thank you for making my very first experience with anesthesia so pleasant!!! "Going under" was one of my biggest fears and I am so happy that my experience was not at all scary!
I remember laying on the operating table and thinking, "I don't feel anything. It's not working!!" The next thing I know I heard my name being called and I was told "You're all done!" I couldn't believe it had been 3 hours. I didn't feel sick or bad at all. I was disoriented, but I just felt like I was woken up from a deep, Ny-Quil induced nap! And I recovered so quickly. I went from feeling a little dizzy, groggy and out of focus to alert and coherent in no time! I even dreamt while I was asleep (and they were normal dreams; nothing weird). I was not in any pain when I woke up. I have had very little pain in fact. The only pain I experienced was back pain and dry mouth (due to nose packing) for the first two days. I am now about 8 days post op and I feel great! I took Vioxx and Tylenol for the first few days, but I haven't needed any pain medication for the last two days.
Thank you for taking the time to talk to my parents and set their minds at ease. My dad is a big worrier and was freaking out before he talked to you. Keep in mind that he was a nervous wreck when I had my baby. He was sure something awful would happen even though I had a perfectly normal pregnancy. So you can imagine what was going through his mind the morning of my surgery!
I am very happy with my new nose and, although my breasts look weird right now, I am sure I will love them soon! You and Dr. Isse make a great team and I will certainly recommend you two to anyone I know who is looking into getting cosmetic surgery.
Thanks again
C. L.
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!
M.C., R.N.
Dear Dr. Friedberg:
First of all, let me apologize for the tardiness of getting this letter to you. I plea that I have been recuperating and also trying to form my thoughts to convey to you the amazing and unbelievable anesthesia, administered by you. Unfortunately, my vocabulary seems so inadequate to express my appreciation for you and the incredible PK procedure.
I must compliment you, not only on your professionalism, but also, your compassion, warmth and understanding. Thank you for emailing me before my surgery, and also for letting me bare my fears and anxiety without judgment. You demonstrated a gentle human side, something that can be an arduous task to find in other medical professionals who deal with cosmetic surgery.
You appreciated the fact that not only was I an RN (and you know what they say about nurses and doctors being the worse patients)! but also, my apprehension and reluctance to subject myself to elective surgery after undergoing over 30 surgeries for an unrelated serious illness. You not only reassured me by explaining everything, but you gave me strength, support and alleviated my fears by holding my hand until after induction.
In all my previous surgeries (including outpatient), I have always had severe post op nausea and vomiting...so bad that after a previous cosmetic procedure I was almost hospitalized. When I awoke from my procedure by you, I felt like I had just woken up from a good night's sleep. I had even forgotten that I had just had surgery. I wasn't in pain, wasn't nauseated. The only thing I remember was that I was thirsty. My friend that accompanied me brought me a smoothie and I had no problem drinking it or keeping it down. I recall telling the staff to please extend to you my compliments and gratitude for making it a good event. As my friends and colleagues ask about my procedure, I make it a point to sing your praises by stating "it was the best anesthesia I have ever had!"
I just wish that I could have you for my personal anesthesiologist for any future surgeries I might have to sustain. You and your procedure are fabulous!
My credos to you Dr. Friedberg! You are truly wonderful!
Sincerely,
Jan, RN
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,
Monique
Dear Dr. Friedberg,
Thank you very much for your excellent work yesterday. Since I have had surgery before, I'd like to give you my comparison between conventional "tube" way and your method.
First, the relaxation pill helped quite a bit. I did not feel the burn that I was so afraid of either. Unfortunately I did not dream of anything pleasant, yet no nightmares either. I typically see dreams every night.
From the conventional way that I've had the job performed before, I was tense… the biggest difference for me was that I did not have to sit in the recovery room for two hours to get my act together. I did not feel sick and did not have that heavy "head from drugs" reaction, which lasted for 24 hours with my prior surgery. I'd say I felt more hyper intoxication in this case, where I felt more energy…after surgery.
Today I feel great, I regret I can't leave the house due to my look, but it seems from the shape of my nose that I think it's finally a good job that I expected from the start.
I will definitely keep you in mind for my future reference. I live in LA and people here are very prone to surgeries of all kinds.
Thank you again,
Irene
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.
Bernie
Dear Dr. Friedberg,
Thank you for taking such good care of me during my surgery on July 9, 2001.
I was nervous but you reassured me. The IV start was painless and I never felt like I was "slipping away." The anesthesia is always one of the scariest parts for me, yet I was never fearful this time while in the OR. In fact, I don't remember a thing!
Thank you for your kindness and professionalism.
Sincerely,
Linda
Dr. Friedberg:
Thank you for the great anesthesia on my daughter, Christina, on 5/14/02. We both appreciate your expertise.
Nice website, also.
M.M., MD
Dr. Friedberg:
I had to let you know, although I probably already did, that you give the best IV's ever. You handled my anesthesia at Dr. Isse's office on Tuesday, July 16 in Burbank. The IV didn't even hurt. I was so thankful after having bad experiences in the past. That was also my first experience with anesthesia, but it was a great one. I was not sick or nauseated afterward-even on the two hour car ride home. I was in a lot of pain afterward, but only in my back due to being wrapped so tightly. My sister had foot surgery in Van Nuys the previous week and was vomiting the whole way home. I feel very fortunate that you were my anesthesiologist. I appreciate how you explained everything to me prior to the procedure as well. Thanks again and take care.
Sincerely,
Angela
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.
Dr. Reginald Edward