Born in Philadelphia, Dr. Barry Friedberg currently lives in beautiful, seaside Corona del Mar, California, over-looking Catalina Island and spectacular winter sunsets.
On March 26, Friedberg began a clinical trial of using propofol to block ketamine hallucinations and using ketamine to prevent intra-operative pain all while avoiding the traditional use of narcotics like morphine or fentanyl during surgery. Narcotics are a class of drug most closely associated with postoperative nausea and vomiting (PONV). By 1993, Friedberg had solved the twin anesthesia vexations of PONV and narcotic requiring, postoperative pain. After Friedberg introduced 1998 FDA approved BIS brain monitor to measure patients’ brain response to propofol doses, he observed a nearly hundred-fold variation between patients to achieve the same level of hypnosis or sleep. The solutions became numerically reproducible, the basis of scientific method. This meant any other anesthesia provider who followed his paradigm would get the same dramatically improved results for his patients.
World-renowned PONV authority, Christian Apfel, originally published the four PONV predictive factors in the New England Journal of Medicine, a rare accomplishment for any anesthesiologist. Non-smoking, female gender, with previous PONV or motion sickness history, having surgery associated with PONV like cosmetic. This description perfectly fits Friedberg’s patients who despite receiving no prophylactic nausea drugs, had the lowest PONV rate (0.6%) in the literature in a in 1999paper by Friedberg. Apfel later cited Friedberg’s paper in his PONV chapter of the highly prestigious Miller’s Anesthesia textbook in both the 2010 and 2015 editions. The PONV chapter is found at number 86 of 89 chapters in Miller,’ indicating a low priority the anesthesia profession holds for this undesirable patient outcome. Although patients do not die from PONV, they only wish they were dead. Patient satisfaction suffers with PONV, and satisfaction now plays a role in third party remuneration for anesthesia services. One day Millers’ PONV chapter may find a place closer to the front of his encyclopedic textbook.
Friedberg remains a man on a mission, a mission to make brain monitoring a standard of care for major surgery under anesthesia. A 2009 mortality study showed one American death daily from anesthesia over medication, the natural consequence a giving anesthesia without measuring the brain, the target organ of the anesthetic drugs. This mortality study also showed 40% or 16 million of the 40 million American patients (many of whom are over 50) every year wake up from anesthesia with brain fog. Friedberg’s anesthesia colleagues remain mystified as to the reason why.
In 2000, Friedberg published a 30% reduction in anesthesia drug use when using a 1996 FDA approved, brain monitor (the forehead sensor connects to a computer that generates a number from 0-100). The lower the number, the more asleep the patient. At the 60-75 range, patients are asleep and do not remember their surgery. Most anesthesia providers are titrating doses in the range well below 45-60, levels considered adequate for general anesthesia. There should be little mystery about why brain fog happens in epidemic numbers in the US.
Tell us about a favorite trip you’ve taken.
Frontiers in Knowledge, a nonprofit education foundation, invited me to conduct two-day, solo educational seminars in Kuala Lumpur and Singapore. These events ran for 8 hours of lecture each day for a total 32 hours of Friedberg speaking and answering questions. By the end of the second day, I could not speak above a whisper which was provident as the original plan was to continue for another two-day session in Dubai.
What attracted you to these places?
I was very flattered by the recognition of the value of my life’s work by an organization halfway around the world and intrigued by the chance to literally to go to the ends of the earth to share my knowledge for safer, simpler, better, more cost-effective and numerically reproducible anesthesia. The students were excited to hear about my novel Goldilocks anesthesia paradigm.
When did you travel there and who did you go with?
Kuala Lumpur lecture series happened on October 25 & 26.th The Singapore event was on the following days, October 28 and 29th 2010.
Please share your memories from the trip.
This trip was made without the company of my beloved wife, Shelley. To compensate for my absence, we used Skype to visit with each other while I was away.
Goldilocks anesthesia students in Singapore
The blue shirt color was not an accidental choice. Prior to my trip, I learned that superstitious Muslins use this color to ward off evil spirits. I wanted to convey a subliminal sense of safety for my students. When I shared this piece of trivia with them, they all agreed the color choice was a good one.
Dr. Donald Ng, a Singapore cosmetic surgeon (below) was so impressed with my work he gave me a return ticket on the once a day, business class flight of Singapore Air. It was the greatest act of selfless generosity I had experienced in my nearly 4 decades of private practice. My trip back across the international date line ‘only’ took 18 hours as opposed to my original itinerary that would have taken nearly twice the amount of flying time with two stopovers. Despite the better travel arrangements, it still took me nearly three weeks to get back on the proper time zone.
What other places have you visited?
I have presented my Goldilocks anesthesia paradigm in Pointe-Claire, Quebec, Canada, Cabo San Lucas, Leon Guanajuato &Veracruz, Mexico, Haifa and Tel Aviv, Israel, and Santo Domingo, Dominican Republic in addition to numerous surgery and anesthesia meetings in the US.
What advice would you give to a first-time traveler?
Pack lightly, prepare for the unexpected and try your best to keep your sense of humor. Nothing ever goes entirely according to your plans. There may be with hotel reservations and unexpected delays in plane flights or connections.