Getting Over Going Under with Dr. Barry Friedberg

posted by David Wolf on Sep 22, 2010 | Comments (0) | Permalink | Trackback URL

A native of southeastern Pennsylvania, Barry L. Friedberg, MD, came to Palo Alto, California in 1975 to complete his formal education with an anesthesia residency at Stanford University with department chief C. Philip Larson, Jr, MD.

Part of the anesthesia residency included time working with cardiac transplant surgical pioneer Norman Shumway, MD. Also while at Stanford, Dr. Friedberg met Thomas Fogarty, M.D., inventor of the Fogarty catheter. Dr. Friedberg was impressed by the elegance of simplicity.

Following the successful completion of his residency and the requirements of the American Board of Anesthesiology, Dr. Friedberg became a Board Certified (or Diplomate) Anesthesiologist in April 1980.

Newport Beach, California has been home to Dr. Friedberg since 1980, initially working at Hoag Memorial Hospital Presbyterian until 1991. Always an innovator, before joining Hoag, Dr. Friedberg introduced their anesthesia staff to the Dinamap in l979, an automated blood pressure device. Many Hoag anesthesiologists openly expressed skepticism, thought it was futuristic and superfluous. (One anesthesiologist even went so far as to say, ‘If they have a machine that takes a blood pressure, what will they want an anesthesiologists for?’) However, it quickly became a well-established way of determining patients’ blood pressures.

Disclaimer: Dr. Friedberg had no financial interest in Applied Medical Research, the company that made the Dinamap.

Dr. Friedberg was also an early adopter of pulse oximetry. When the technology first became commercially available in 1983, he went to the hospital administrator to encourage the hospital to purchase units for every anesthetizing location. Not until 1990 did the American Society of Anesthesiologists (ASA) before declare this safety monitor a standard of care.

Disclaimer: Dr. Friedberg had no financial interest in Nellcor, the company that made the N-100 pulse oximeter.

At Hoag, during the 5 years Dr. Friedberg practiced the subspecialty of cardiac (open heart) anesthesia, he introduced the Swan Ganz catheter and cardiac output computer to the heart team. With Dr. Friedberg giving their anesthesia, the heart surgeons were able to know the patient’s cardiac output and peripheral resistance immediately when coming off bypass pump for the first time in the program’s history.

In the fall of 1986, Dr. Friedberg turned his professional attention to outpatient surgery for 4 years at Hoag’s James Irvine Surgicenter. Moving from an institutional outpatient setting to the office-based one was a natural growth in Dr. Friedberg’s career in 1991.

Dr. Friedberg developed propofol ketamine (PK) anesthesia in 1992. His approach was derived from the mid 1970s diazepam (Valium®) ketamine anesthesia published by Vinnik in 1981 and further popularized by other plastic surgeons like Baker, Stuzin and Ersek.

PK anesthesia was designed to maximize patient safety while imitating general anesthesia. Patients do not hear, feel or remember their surgical experience.

Since 1993, Dr. Friedberg has practiced exclusively in the subspecialty of office-based anesthesia (OBA) for elective cosmetic surgery. Because of the unique challenges in the office-based setting, Dr. Friedberg saw a need for education of his hospital based colleagues who might choose a path similar to his own. The Society for Office Anesthesiologists (SOFA) was founded in 1996 and merged in 1998 with the Society for Office Based Anesthesia (SOBA), another non-profit, international society dedicated to improving patient safety through education.

Economic forces in the late 20th century have forced more procedures away from the hospital and surgicenters and into office-based settings. The ASA and SAMBA have subsequently conceded that OBA is a legitimate subspecialty of ambulatory anesthesia.

In 1997, Dr. Friedberg became the first anesthesiologist in Orange County, CA, to begin routinely monitoring his patients with a brain activity monitor, adding a significant refinement to PK anesthesia. Many anesthesiologists expressed similar skepticism about brain activity monitoring that they had expressed nearly 20 years earlier about the Dinamap.

Disclaimer: Dr. Friedberg has no financial interest in any of the makers of brain activity monitors.

More and more enlightened anesthesiologists in the United States, Canada, England, Ireland, Japan, Australia, and a growing list of other countries have enthusiastically incorporated PK anesthesia into their practices, much to the delight of their patients and surgeons.

When Olivia Goldsmith, author of ‘The First Wives’ Club’ died in 2004, the need for the a comprehensive textbook in the field of cosmetic surgery anesthesia became apparent. Dr. Friedberg’s reputation and extensive publications in the field made him the first choice among the then 40,000 US anesthesiologists.

Cambridge University Press published Dr. Friedberg’s ‘Anesthesia in Cosmetic Surgery’ in April 2007 in English, followed by the book’s Portuguese translation for Brazil in June 2009. Brazil performs the most cosmetic surgery of any country in the world.

A list of Dr. Friedberg’s publications can be accessed from his Curriculum Vitae, provided upon request.

Subsequent citations of Dr. Friedberg’s PK anesthesia articles are noteworthy because half of all published journal articles are never referred to in later journal articles by other authors. Dr. Friedberg’s articles have been subsequently cited in over 60 journal articles. His articles have also been cited in 20 textbooks including Barash 6th ed. Clinical Anesthesia and the 2010 encyclopedic Miller’s Anesthesia (7th ed).

The Karolinska Institute is the foremost medical center of Sweden. The ‘Minimally invasive anesthesia for minimally invasive surgery’ article in Outpatient Surgery Magazine (Feb. 2004) was posted on the Karolinska Institute web site.

Dr. Friedberg is recognized as a medical expert in anesthesia by the California Medical Board in addition to the legal profession. His expertise has been lent to a number of peer-reviewed medical journals for review. Dr. Friedberg is also a contributor to the letters to the editor section in several anesthesia and surgery journals.

From 1998 through 2008, Dr. Friedberg was Assistant Professor of Anesthesia, volunteer faculty, at University of Southern California from 1998-2008, and Associate Professor of Anesthesia at the University of California, Irvine, Volunteer Clinical Faculty in 2009.

He has also lectured to anesthesiologists and surgeons in the United States, Canada, Mexico, the Dominican Republic, Israel and Venezuela. Dr. Friedberg’s expertise for safer, simpler, cost-effective and better patient outcomes was shared at 2009 Grand Rounds for the anesthesia residents at the prestigious Cedars Sinai Hospital, the January 2010 Biennial Pan Pacific Plastic Surgeon’s meeting in Honolulu, and the upcoming May 2010 Grand Rounds for the anesthesia residents at UCLA.

FILED IN: Publishing, The Business of Health