About PK


Providing pain relief without using narcotics like morphine, Demerol or fentanyl, Dr. Friedberg sets the stage for patients to wake up from their anesthesia with minimal discomfort and essentially no postoperative nausea and vomiting (PONV). This propofol ketamine (PK) technique is designed to maximize patient safety while creating the illusion of general inhalation anesthesia, i.e. "no hear, no feel." For maximum results, Dr. Friedberg has adopted the use of the Bispectral Index® (BIS®) monitor (Aspect Medical Systems, Inc., Newton, MA - www.aspectms.com). The BIS monitor plays a crucial role by measuring the safe range of propofol at which the ketamine can be given.

BIS Value

0 - 100 Range
98 - 100 Awake
60 - 75 MIA
45 - 60 GA
<45 Overdosed

The BIS is an index and, as such, does not have any units like pounds or inches. The lower the number, the deeper the patient's level of sleep or hypnosis. Most patients desire not to hear, feel, or remember their surgery. This phenomenon is commonly associated with GA or 'general anesthesia.'

The identical experience can be achieved using less medication to a BIS level of 60-75 or the MIA or 'minimally invasive anesthesia® technique pioneered by Dr. Friedberg. By using less medication to achieve the same effect as GA, patients wake up from anesthesia quicker and more clear headed than with GA.

For the past decade, Dr. Friedberg has devoted himself exclusively to the field of elective cosmetic surgery anesthesia. Dr. Friedberg is credited with pioneering this innovative anesthetic technique for office-based surgery that eliminates PONV. Employing the BIS technology, Dr. Friedberg custom fits each anesthetic to the individual patient, rather than relying on an "off the rack, one size fits most" approach commonly used in the anesthesia community. A growing number of anesthesiologists, including physicians in the US, UK, Australia, Canada, and Japan, have enthusiastically embraced Dr. Friedberg's technique.


Patients benefit from Dr. Friedberg's discovery that tames the rare, negative side effects of ketamine, considered the safest drug in the anesthesiologist's toolbox. The BIS monitor plays a crucial role by measuring the range of propofol at which the ketamine can be safely given.

Ketamine produces a brief, dissociative condition during which the surgeon can inject local anesthesia for the planned surgery without hurting the patient. Using this unique approach for office-based anesthesia eliminates the need for opioid medications like morphine, Demerol or fentanyl, which are commonly used in the anesthesia community. Without the opioids, the unpleasant problem of post-operative vomiting and nausea (PONV) after anesthesia is essentially eliminated!

Increasingly, patients who have spent time researching the different anesthesia options available to them, or those choosing to have additional elective cosmetic surgery, are requesting this technique to avoid the PONV that they have experienced with prior anesthesia.


Dr. Friedberg has successfully used PK for hernia repairs, female gynecological laparoscopy, arthroscopy (e.g., knee, shoulder, elbow), and lithotripsy. Many of these results were described in his five-year review article published in Aesthetic Plastic Surgery 1999; 23:70-75. (Patients' identities were not revealed.) There were no patients admitted post-operatively to the hospital for uncontrollable pain or PONV, two most common causes of postoperative admission following an outpatient surgery.

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