Anesthesia and Cosmetic Surgery
Anesthesia is often an area that is overlooked when a person is educating themselves about cosmetic surgery. I know that this is one of the most important areas that you should investigate.
Some surgeons use nurse anesthetists and some give anesthesia themselves. I only use physicians that are board-certified anesthesiologists and believe that this is the safest approach. It is only logical... there is an expert tending to the monitors while I am tending to the surgery!
I am frequently asked if cases such as wide area liposuction, breast implants and facelifts can be done under local anesthesia, or local anesthesia with IV sedation. I do not think that the question should be "can it be done", but instead should be "what is the safest way".
The large area, like the front of your entire chest, cannot be adequately blocked with a safe dose of local anesthetic, to make you feel totally comfortable through the surgery. If we add intravenous sedation to this, it could be done.
Intravenous sedation means giving medications similar to Valium and pain medicines through an IV. When this is done, you tend to wake up more quickly and feel better than someone who has inhalation anesthesia (gas).
I use intravenous sedation and local anesthesia for almost all of my surgeries, but here is where it can get a little confusing. With intravenous sedation, frequently the patient is actually sleeping. Because however, it is intravenous sedation and not general, there is often no airway tube placed. Therefore, it is possible for the airway to be blocked by the tongue or for saliva to collect and be inhaled. There are definitely monitors to protect against a lack of oxygen, and this can be corrected by the person giving anesthesia. I think that it is better to avoid this problem at all rather than correct it!
In most of my cases, the anesthesiologist uses a mini-tube called a Laryngeal Mask Airway (LMA). This tube is similar to the plastic airway found in a first-aid kit but has a short pipe about the thickness of two of your thumbs and a rubber balloon at the bottom. The balloon holds the tongue out of the way and the short pipe passes the air as you breathe in and out. This LMA is placed after the sedation is given and removed before it is stopped, so you never know you had it at all! Since it is not a full length tube, there is no sore throat.
Because there is a type of tube placed, by the true definition of the word this is called general anesthesia. We actually use the intravenous sedation medications though, and I believe that having a secure airway to assure excellent passage of air without any obstruction gives you the best of both worlds. Waking up quickly feeling better because there is no gas used, but having the safety of the mini-tube.
