Physicians, like all people, live in a world that is proscribed more by what we do in rote fashion every day than by what we understand in any meaningful way. Our modern lives have become so harried that most of us barely have enough time to pause and reflect on what we have done and where we are going.

Dr. Barry Friedberg, at great personal effort and time, has put forth this pearl of a book: ideas, methods of practice, and salient knowledge on the cutting edge of modern medical practice as they apply to the world of minimally invasive anesthesia for cosmetic surgery. As many of our practices prove every day in operating rooms across the United States and beyond, the information and anecdotes provided here apply equally well to a whole host of different anesthetic and surgical settings.

Modern science is replete with heroic strides in improving patient care and decreasing perioperative morbidity and mortality — and yet, today, we still do not understand the underlying mechanisms of general anesthesia on the brain, much less the construct of consciousness itself!

The field of anesthesiology and perioperative medicine achieved unprecedented gains in patient outcomes through the advent of pulse oximetry decades ago. Since then, we have refined our techniques, implemented new airway devices, decreased postoperative nausea and vomiting, improved our times to “street readiness,” and done a better job of managing pain. Now is the time to move to the next level of patient care.