Olivia Goldsmith, author of ‘The First Wives’ Club,’ died having cosmetic surgery. This, as well as virtually every, reported death from cosmetic surgery was avoidable.

With a 446% increase in cosmetic procedures since 1997, Friedberg’s 'Anesthesia in Cosmetic Surgery' from Cambridge University Press is a timely arrival.

Although the book is primarily designed for the profession, the public needs an awareness of a safer alternative to commonly employed anesthesia for cosmetic surgery. Much like the days before fathers were permitted to observe the birth of their children, the public needs to be empowered to ask for safer anesthesia!

On August 1, 2001, www.drfriedberg.com was launched as a non-commercial patient oriented web site to empower patients to know there were anesthesia options and to ask for them! Anesthesia in Cosmetic Surgery is the next step in this empowerment.

All cosmetic surgery takes place on the superficial layers (‘the wrapper’) of the body.

As such, all cosmetic surgery must be considered minimally invasive, despite the length of the surgery or the extent of the dissection.

Minimally invasive anesthesia (MIA)® is only logical for minimally invasive surgery. Growing numbers of anesthesiologists are beginning to share this view but more need to be asked to provide it for cosmetic surgery. Only the general public can provide this force for change.

Fundamental to the administration of MIA is the use of a level of consciousness monitor like the bispectral index (BIS). Approved for this use in 1996 by the FDA, universal use of BIS has not yet occurred.

Prior to BIS monitoring, anesthesiologists were obliged to guess at the correct dosage and, for fear of under-medicating, routinely overmedicated by a factor of at least 20-30%. Anesthesia was the art of the ‘controlled overdose.’ The advent of BIS monitoring has made that style of practice unnecessary and potentially dangerous.

BIS provides a number between 0-100 derived from information obtained from the sensor on the patient’s forehead. The lower the number, the deeper the level of consciousness, sleep or ‘hypnosis,’ as it is known in the anesthesia profession.

General anesthesia sleep levels occur between 45-60. The patient doesn’t hear, feel, or remember their surgery with general anesthesia. The same experience can be had with intravenous propofol at BIS between 60-75, a level Dr. Friedberg has trademarked as an integral part of MIA.

BIS levels below 45 are considered overmedicating (‘controlled overdose’) and suboptimal for long-term safety. The brain is the target organ for the anesthesiologists’ medications. This information is not obtainable with any current vital signs monitors. No elective cosmetic surgery patient should have anesthesia without a BIS or similar level of consciousness monitor. Therefore, Dr. Friedberg deems the BIS a standard of care.

Cosmetic surgery patients continue to needlessly suffer postoperative nausea and vomiting (PONV) and unnecessary pain after many surgical procedures including cosmetic surgery. Most cosmetic surgery patients receive local anesthesia injection after receiving general anesthesia. This process fails to predictably produce ‘pre-emptive analgesia’ or substantial postoperative pain relief. General anesthesia does not block all of the pain signals from the local injection from reaching the brain. MIA does block all painful signals thereby reproducibly provides preemptive analgesia without the use of agents that cause PONV. MIA also preserves leg muscle tone, avoiding phlebitis along with lethal pulmonary embolism.

Barry L. Friedberg, M.D. has been in active practice exclusively in office-based anesthesia for cosmetic surgery since 1992. He is an assistant professor in anesthesia at University of Southern California, volunteer faculty. He has published 30 letters to the editor, 14 articles and 6 book chapters including 3 in 'Anesthesia in Cosmetic Surgery.'

Among the 'firsts' in the book are 1) first book in the field, 2) first book to feature a level of consciousness monitor (i.e. BIS) on the cover, 3) first medical book to start with a quote from a Bob Dylaan lyric, & 40 first anesstehsia textbook to assign numericaal values to levels of sedation/anesthesia.

His work has been cited in most of the major anesthesia textbooks including Miller’s Anesthesia & Barasch’ Clinical Anesthesia. Friedberg was recently awarded the Certificate of Special Congressional Recognition for his work’s use in military anesthesia. He has also lectured to the anesthesia profession in the United States and abroad. He is available to the media for interviews.

Disclaimer: Dr. Friedberg is not employed by Aspect Medical Systems, makers of the BIS monitor. He is not a stockholder or a paid consultant. The opinions expressed herein are his professional opinion based on 10 years experience with BIS monitoring.


Contact:

Barry L. Friedberg, M.D.

Anesthesia for Cosmetic Surgery

TEL (949) 233-8845

Email: drfriedberg@doctorfriedberg.com

http://www.doctorfriedberg.com

Absolutamente de acuerdo. I absolutely agree with you. May I ask what information you have about cases of death patients in other countries? I´m currently in Argentina and I have researched a lot about death patients while having plastic or cosmetic procedures and I found out that most of the clinics where people have their surgeries are not GENERAL HOSPITALS. Do you think it might become a risk factor for plastic surgery? SOLEDAD ARENALES. ARGENTINA

I have no information in countries outside the US. I do not believe there is anything about human physiology unique to non-US countries. I have performed anesthesia for cosmetic surgery for the past 15 years outside of an acute hospital setting in accreditied physicians' offices. While accreditation is not a panacea for patient safety, it does assure that the basics for patient safety are physically present. These basics are oxygen, Ambu bag (or other positive pressure ventilation device), suction, vital signs monitors, a defibrillator & a 'crash' cart. None of these physical requirements can guarantee that sound clinical judgement is being practiced both in patient selection and reasonableness of surgical trespass.

As a point of comparison, the 'typical' anesthesiologist uses 12-15 drugs for general anesthesia whereas my MIA technique only requires 3. Safety through simplicity.

In the US, we have found that liposuction in excess of 5,000 ccs in a single setting is associated with higher complication rates. Duration of surgery can become an issue if lack of body heat preservation or blood loss becomes an issue. Generally speaking, office based or outpatient clinic based surgery is excess of 6 hours, while not specifically prohibited, is frowned upon in the office based setting.

I have been told that in Argentina and Brazil, the cost of overnight hospital stays are dramatically lower than in the US and patients are conditioned to expect to stay overnight. This is the exception rather than the rule in the US where the costs of an overnight stay in a hospital are generally prohibitive.

One of the many advantages of my MIA technique is that patients have minimal postoperative pain and are able to go home soon after their surgery. Preemptive analgesia for the surgery and non-narcotic postoperative pain management has greatly contributed to patient satisfaction and safety. Without significant pain, patients readily resume walking even after abdominoplasty. This has eliminated the experience of pulmonary emboli (or clots) which have been fatal in patients unable to walk after surgery due to pain. Avoiding narcotics as well as inhalational vapors with MIA technique has eliminated 99.5% of all postoperative nausea and vomiting. Last and certainly not least is that patients nearly uniformly experience happiness from the propofol. One of the articles I wrote years ago inflamed my colleagues because the title was 'Happy drugs for happy surgery.' I have been the hero to my patients. Anesthesiologists who have adopted my technique report similar results.

Poor girl,,,plasticsurgery shall be treated as risky as other surgeries