Facelift surgery is performed under either intravenous (IV) sedation, or performed under general inhalational anesthesia (GIA).

Drugs like desflurane, sevoflurane, and isoflurane for GIA are triggering agents for the very rare, often fatal syndrome of malignant hyperthermia (www.mhaus.org). Although the risk is low, Dr. Friedberg feels it is unacceptable when the PK technique is a proven alternative.

In addition to the issue of unnecessary exposure to triggering agents, the use of GIA for facelift involves intubation of the airway with a breathing (endotracheal) tube. The act of intubation includes the possibility of damage to the teeth, and the likelihood of sore throat after the anesthetic.

Many anesthesiologists favor the combination of propofol and alfentanil (a short acting, synthetic opioid) for IV sedation). Opioids are reported to have a 15 to 40 percent PONV rate. The best published PONV rates for an opioid-based technique, using two anti-nausea medicines, is 8.3 percent. While an 8.3 percent PONV rate is certainly an improvement over 15 to 40 percent, it is especially unacceptable for facelift patients. Even when opioids are avoided and only general inhalational anesthesia is used along with three anti-nausea medicines, a three percent PONV rate is the best outcome published.

A growing number of anesthesiologists in the US, UK, Australia, Canada, and Japan have embraced Dr. Friedberg's PK technique for better results and outcomes. He published a 0.6 percent PONV rate, without the use of any anti-nausea medicines, in his five-year, 1,264 patient review article published in Aesthetic Plastic Surgery 1999; 23:70-75. (No patient identifications were revealed.) Preemptive, non-opioid pain relief with adequate local anesthesia, along with opioid avoidance, is credited for these unparalleled results.

The PK technique has been greatly simplified by the addition of the Bispectral Index® (BIS®) monitor (Aspect Medical System, Inc., Newton, MA - www.aspectms.com). With the monitor's measurement aid, the anesthesiologist knows just the right amount of anesthetic needed by the patient so that the patient receives no more anesthetic than absolutely necessary. In more medical terms, the monitor permits quantification of the safe range of propofol. This is important in helping to prevent the rare occurrence of rare occurrence of hallucinations from ketamine; arguably, the safest anesthetic drug in the anesthesiologist's toolbox. The dissociative state ketamine produces allows the injection of the local anesthetic into a motionless patient. In this way, the injection and the subsequent surgery provide no perceived pain stimulus to the patient. When the propofol infusion is turned off, patients awaken quickly with little discomfort and no PONV. With a rapid return to their pre-anesthetic mental state, patients are able to return home soon after their surgery is completed, with their surgeon's approval.

Bispectral Index® (BIS®) monitor   www.aspectms.com

Details of Dr. Friedberg's innovative PK technique, which provides narcotic-free pain relief, were published in Aesthetic Plastic Surgery 1993; 17:297-300. (No patient's identities were revealed.) The technique is designed to maximize patient safety while creating the illusion of general inhalation anesthesia, i.e. "no hear, no feel." The article has been subsequently cited in twelve peer-reviewed journal articles, and one surgery and four anesthesia textbooks. This is noteworthy because half of all journal articles in print are never referred to in subsequent articles. Several subsequent articles by Dr. Friedberg have also been published.

The most recent publication about Dr. Friedberg's PK technique for facelift appears in Dermatologic Surgery 2000;26:848-52.

In the past decade, Dr. Friedberg has successfully performed his PK technique for facelifts with more than 25 different surgeons on more than 250 patients. No patients were subsequently admitted to the hospital for either uncontrollable pain or PONV, the two most common causes of post-operative hospital admission following an outpatient surgery procedure.