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Related Experiment Videos

Can Friedberg's Triad Solve Persistent Anesthesia Problems? Over-Medication, Pain Management, Postoperative Nausea

Barry L Friedberg1

  • 1Goldilocks Anesthesia Foundation, Newport Beach, Calif.

Plastic and Reconstructive Surgery. Global Open
|November 30, 2017
PubMed
Summary

Friedberg's Triad addresses anesthesia challenges by monitoring brain activity with the bispectral (BIS) index and electromyogram (EMG), preempting pain, and avoiding emetic drugs.

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Area of Science:

  • Anesthesiology
  • Neuroscience
  • Surgical Care

Background:

  • Persistent anesthesia issues include medication errors, pain, nausea, and vomiting.
  • Traditional monitoring (heart rate, blood pressure) inadequately reflects cortical brain activity.
  • The bispectral (BIS) index and frontalis electromyogram (EMG) offer real-time cortical monitoring.

Purpose of the Study:

  • To introduce and validate Friedberg's Triad for managing anesthesia.
  • To demonstrate the efficacy of BIS/EMG monitoring in titrating propofol.
  • To reduce postoperative pain, nausea, and vomiting.

Main Methods:

  • Utilizing the propofol-ketamine paradigm with BIS/EMG monitoring.
  • Titrating propofol to maintain BIS index between 60-75 with baseline EMG.

Related Experiment Videos

  • Implementing Friedberg's Triad: brain monitoring, pain prevention, and antiemetic avoidance.

    • Main Results:

    • BIS/EMG monitoring provides real-time assessment of propofol's cortical effect.
    • Titration to BIS 60-75 ensures consistent anesthetic depth despite variable propofol needs.
    • 25 years of clinical experience showed no hospital admissions for pain or nausea/vomiting in office-based cosmetic surgery patients.

    Conclusions:

    • Friedberg's Triad effectively addresses persistent anesthesia problems.
    • Real-time BIS/EMG monitoring allows precise anesthetic titration.
    • The triad paradigm significantly improves patient outcomes by reducing postoperative complications.