#1: Don't Be Afraid of the Anesthesiologist

Dr. Barrett sits down with anesthesiologist Dr. Farzad Mahjoubi to discuss what really happens when anesthesia is performed and the new science behind Ketamine as mental health treatment.

This podcast was recorded at my surgical center, Barrett Plastic Surgery in Beverly Hills. We have a special guest for you. This is Dr. Farzad Mahjoubi, and he is a . He actually works with us quite a bit and so we are really excited to have him here and he does a lot more than just anesthesia.


Dr. Farzad Mahjoubi: Thank you so much. Thank you for having me.

Dr. Barrett: Yes. Tell us who you are and what you do.

Dr. Farzad Mahjoubi: I’m a Board Certified Anesthesiologist. I’ve been doing anesthesia for ten years now. I’m also medical director of The Healing Academy in Los Angeles. That is something else I do. I do anesthesia primarily for plastic surgery centers right now. I used to work at Northridge Hospital, which is in the San Fernando Valley. A bit different from plastic surgery in terms of there is the cases because we had lung cases, heart cases, cardiac bypass, etc. Plastic surgery is, as you know, different. And currently, that is what I do.

Dr. Barrett: Absolutely. You are one of our main anesthesiologists here at Barrett Plastic Surgery. We do a lot of plastic surgery, mainly here, and patients absolutely love you. I think you do a fantastic job, and that is why I was excited to get you on here so you can share a little bit about what you do here.


What would a patient expect? Let say someone is interested in getting breast augmentation, what is something that they should expect to happen when it comes to anesthesia?

Dr. Farzad Mahjoubi: Well, first and foremost it is very safe. In the hands of properly trained anesthesiologist the chances of anything happening is virtually zero. In terms of questions and what to ask, patients usually talk to me the night before the surgery and I answer any question they may have. The day of the surgery such as breast augmentation they walk into the operating room with a tiny pediatric size IV on place of catheter that they barely feel and the next thing they know, they are waking up when the surgery is finished.

Dr. Barrett: I mean this is so true. This is why we have Dr. Farzad Mahjoubi here, because he makes the process so smooth, so safe. I mean, you really want to have someone that is as credentialed as

Dr. Farzad Mahjoubi is and experience that he has. I get a lot of questions from the patients like, how am I going to optimize the surgery?


The risk of complications from breast augmentation is pretty low for surgical complications and even way less for anesthesia. That is the question they ask about anesthesia. I am really scared to go under anesthesia. I mean it is completely safe but do you have any statistics? I thought I saw something like a major adverse reaction for someone super healthy is one in a million or one in two million.

Dr. Farzad Mahjoubi: Right, that is correct actually. I have been doing this for ten years and nothing has ever happened and I have done over probably 15,000-20,000 cases. IT is really in the hands of board-certified anesthesiologist. Surgery at a plastic surgery center and plastic surgery specifically is extremely safe.


Dr. Barrett: Great. I agree. I want to dive into learning about Dr. Farzad Mahjoubi a little bit more. So you are extremely talented. You do an amazing job at anesthesia but tell us a little bit about your background? What made you want to go to anesthesia? What happened with your training? I know you trained at USC which is really top-notch program, because I trained there. Our training actually overlapped and we had some funny experiences like a breathwave during one-year window. Give us the Dr. Farzad Mahjoubi story.

Dr. Farzad Mahjoubi I went to med school in Chicago and originally wanted to be a neurologist. I was doing Alzheimer’s research at UC Irvine at Orange County and started doing some rotations on pediatrics, OB and I kept seeing anesthesiologists whether they were placing epidurals or anesthetizing little kids or adults. And I was like wow this is cool. And not to mention that I was very interested in pharmacology and that is cool so I thought it was a great combination to experience different specialties in addition to practice the pharmacology that I have learned and in addition to physio. So, I went to anesthesia, trained at USC like yourself and basically came out and I was working in a hospital on cases that were extremely tough. And that is another thing, when anesthesiologist has worked at hospital where was a lot of challenging cases, patients were a lot older with a lot more medical or health problems, coming to a surgical center where most patients are healthy with surgeries that are mostly routine. Not to say it is easy. You should never have an ego about anything, but it is really different. The cases at hospitals are a lot more challenging.


Dr. Barrett: Right. So, if anything bad would happen you are the guy that could beat that because you know how to handle it. You are always so smooth and calm and collected with anything that happens during surgery. Not only that, but you time everything perfectly. In cosmetic surgery center there is definitely safety things but then there are really nicer touch things. You know, patients wake up pain free, they don’t wake up nauseous, they don’t wake up confused. The way that you really find the way to tune the anesthesia, to me it is like an art form. I spent a lot of time on plastic surgery and perfecting that but I think you really perfected anesthesia that you do so that patients really. Basically, you just show up, take it from here and it is really smooth process and that is what my patients love about you.

Dr. Farzad Mahjoubi Thank you so much. Thank you for the compliments. I’d like to add that you are an amazing Plastic Surgeon. One of my favorite plastic surgeons I work with, mostly because you are so smooth and patients are always happy and love their results. I make it to a point to work with a plastic surgeon that are very safe, very focused and very good. And you are definitely one of those.

Dr. Barrett: Wonderful. I want to know what is… You have so many thousands of cases done, have you ever had any difficult, challenging case, something that you are willing to share to listeners? Something that might be interesting or kind of crazy or…I know the county hospital where we trained, there were crazy stuff all the time, just to give our listeners a taste of what … or one particular case you have done.

Dr. Farzad Mahjoubi: As I mentioned in a Plastic Surgery Center everything is a pretty routine but I do recall that at County Hospital we had a patient who had overdosed on a diet pill and she had ruined her liver. She came in for a liver transplant and we started that.

Dr. Barrett: Overdosed, a diet pill overdose can cause liver failure. Listeners check that out. Be very careful with what you take. Was it a prescription or some herbal thing?

Dr. Farzad Mahjoubi: I think it was some herbal thing from China. She survived. She came in requiring a liver transplant ASAP. We started that at noon on a Sunday, around 09 p.m. the same day she had a kidney failure so we had to do dialysis and kidneys came back. Her liver took really well and she went back to school but that surgery lasted 28 hours.

Dr. Barrett: Did you stay whole time?
Dr. Farzad Mahjoubi: I stayed 24.

Dr. Barrett: there is only so much you can do without some kind of a break. You are not going to be your best.
Dr. Farzad Mahjoubi: Surgeons stayed there the whole time. You guys have more stamina.


Dr. Barrett: I don’t know if that is a good thing or not. What do you love personally about anesthesia? We know that you had some great experiences when you were in med school, but what is that you love now about doing anesthesia?

Dr. Farzad Mahjoubi: I mean definitely seeing a different type of surgeries, rhinoplasty, breast augmentation, tummy tuck like one you did today, Brazilian Butt Lifts. Everything else that can be done in hospital, whether it is knee replacement, lung resection, there is so many types of surgery that you can see. It is interesting, pathology is interesting. Also, meeting new people, new surgeons. It is great comradery, it is great to be part of a team that works great together, that is a well-oiled machine like that you have here. And that is really what I enjoy. Going home satisfied at the end of a day knowing that I made a difference whether it is cosmetic or for more serious medical condition.


Dr. Barrett: Awesome. So I have a question from my listener… From Lancaster. Dear Dr. Barrett, on TV I heard about a patient waking up during surgery. Is this a real thing? And this might be a perfect question for Dr. Farzad Mahjoubi because I have never seen this happen. Maybe you can elaborate.

Dr. Farzad Mahjoubi: I have never seen it happen either. It would require anesthesiologist to pretty much be asleep and not turn on the anesthesia whether it’s gas that he is using or IV anesthetic such as Propofol. That is really all it takes for patient to have awareness. In addition, the anesthesiologist would have to paralyze the patient, to give a medication that weakens the muscles and not turn on the anesthesia part for patient not to be able to move and let everyone know that they are awake. So, it is so rare. It certainly never happened under my watch and I’ve never heard it happening in hospital that I’ve worked, during my residency. I actually never heard it happening. But I know there is a whole movie about it called Awareness.


Dr. Barrett: Yeah. I know. People catch these rumors and it scares them away from doing very safe surgeries. I know enough about anesthesia to know that you really have to not know what you are doing to make that situation happen. And that is why we do our surgeries in fully accredited Surgery Centers. We have checklists, protocols, every single day we do timeouts before each and every surgery. We just did three surgeries today. They all went very smooth and safe. That just really reinforces… When you get plastic surgery, you want to get a board-certified anesthesiologist, especially someone with experience like yourself. We make sure that we don’t cut any corners here at Barrett plastic surgery to make sure that the patients get that quality and safety. You are really fascinating, you actually got a couple other things that you are kind of taking a lead in Los Angeles. I think that our listeners would like to hear more about and me and myself. A lot of work to do with depression and things like that. I love to kind of dive into that and more about some other treatments that you are actually providing besides when you are not doing surgeries here with me obviously because I am not operating five days a week. It is like three. I operate three day a week but other days you do what’s called Ketamine infusions. Tell us about that.


Dr. Farzad Mahjoubi: Well. Ketamine is anesthetic. It was basically man made about 60 years ago and it was made because when we needed something to induce anesthesia that is really stable that not bring down blood pressure and heart rate. Essentially it was used by the military if any surgery would have to be done on the field. However, through the seventies and eighties it was realized that psychedelic medications which Ketamine can be one of if you give the right dose, helped people with depression, with long-term depression, with treatment resistant depression. It was used sparingly throughout the years. Five years ago, I read an article about this and given the fact that I had extensive training with Ketamine dating back to residency in 2006.

Dr. Barrett: In pediatric situations, I remember going in to saw up lacerations for kids and we would give them Ketamine just for a brief moment, completely monitored in the emergency room and they would go to sleep and then wake up. I never understood why the doctors, anesthesiologists would take care of it but it just seemed to work like a …. but I never really understood about it. I had no clue until you told me that there are other thing that Ketamine is good for.


Dr. Farzad Mahjoubi: Right, right. It got so many uses. It’s amazing for PTSD, actually. Virtually 95-100% of patient with PTSD…

Dr. Barrett: Tell us what is PTSD?

Dr. Farzad Mahjoubi: Well, post-traumatic stress disorder is caused by a traumatic event in one’s life. It could be anything that causes trauma, psychological trauma that results in depression and/or anxiety.

Dr. Barrett: This is real serious stuff, PTSD

Dr. Farzad Mahjoubi: So Ketamine is great for that. It is great for long-standing depression and also complex regional pain syndrome because it blocks pain receptors which is one reason we use it in operating room.

Dr. Barrett: No kidding

Dr. Farzad Mahjoubi: Yes, it is both amnestic and analgesic, which means, analgesic means relief of pain and amnesia means causing amnesia or anesthesia so…I used it with great success in patients that can’t get pain relief from other modalities, for various pain syndromes. So that is what I do in Ketamine Healing Clinic in Los Angeles.

Dr. Barrett: That is amazing. How many patients are you really helping right now? Can you quantify this? Does everybody that comes in feel better or is it like one in ten. What is a good sense for success of these infusions?

Dr. Farzad Mahjoubi: It is a great question. For patients with depression and PTSD, at least 80% of patients I see get relief if not more.

Dr. Barrett: Are these people that tried everything else perhaps. And this is their last resort?

Dr. Farzad Mahjoubi: Yes. A lot of times psychiatric medications either lose their effect the side effects are not bearable for long periods. And Ketamine treatment for depression is relatively side effect free.
Dr. Barrett: Is this like a one-time treatment or is this something that people have to kind of come back to see on regular basis?

Dr. Farzad Mahjoubi: Great question again. We generally recommend five treatments over two weeks. Five to six is the sweet spot for most people and that seems to give the long-lasting results that we like to see. At my clinic I prescribe the nasal spray afterwards for home use and that continues and maintains the benefits.


Dr. Barrett: When someone does the nasal spray, do the need to be on the couch, and like handcuffed make sure they don’t get out, go crazy or is this kind of like a lighter kind of version?
Dr. Farzad Mahjoubi: Much lighter. And I set a maximum per day

Dr. Barrett: OK. So, you get to control the dose based of the patients.
Dr. Farzad Mahjoubi: Yes.

Dr. Barrett: And then after they do the nasal spray do they check in with you or do they come back after a year. For me, people get their Botox but they have to come back every 3-4 months. Until we come out with long-lasting Botox I see my patients a lot. You tell me.

Dr. Farzad Mahjoubi: It definitely depends on the patient. There is so many types of depression out there. People come from different backgrounds. So, for some people, I see a relief that lasts over a year. Other people do have to some back every 2-3 months for one booster infusion as we call it. Or maintenance infusion. That’s you why don’t have to do 5 treatments again.

Dr. Barrett: Amazing. That is great. This is really new. I know you are one of the few providers that do this and it is such a needed thing in Los Angeles and probably in the world if you ask me. In United Stated it is a huge depression epidemic and suicides because of depression. How can people find out more about your services or find out what if Ketamine infusion is an option for them?

Dr. Farzad Mahjoubi: Well, my website has a lot of great info on there, especially frequently asked questions page. You just go on ketaminehealing.com/the-doctor or they can call 866-987-7874. But otherwise, you can just google Ketamine and a lot of information will come up. Not all of it is correct though so I do recommend going on a proper website to learn about it.

Dr. Barrett: that is amazing. Great. Dr. Farzad Mahjoubi, thank you again for a wonderful day in operating room. We had some amazing surgeries today. We look forward to next week and for all you listeners out there, if you want to find out more information about the Dr. Farzad Mahjoubi and special things he does with Ketamine infusions, check out his website again. ketaminehealing.com/the-doctor. And feel free to check out our website too if you have any questions, barrettplasticsurgery.com. Thank you for tuning in. And Dr. Farzad Mahjoubi, thank you for being here.

Dr. Farzad Mahjoubi: Thank you as always.

Dr. Barrett: Thank you for listening to this podcast. If you want more information about plastic surgery and our secrets, please visit my website at drdanielbarrett.com.