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.
