Questions about plastic surgery anesthesia are some of the most common fielded by Dr. Loeb during an initial one-on-one consultation with a patient. “Will I be awake?” patients ask. “Will I feel any pain?” It Dr. Loeb’s job, as one of NYC’s most respected cosmetic surgeons, to ensure that you are as calm and comfortable as possible throughout the entire procedure, while also taking the steps necessary to minimize risk.

General anesthesia is most commonly used, but there are circumstances where IV sedation and local anesthesia are preferred. At Dr. Loeb’s accredited surgical facility, only certified anesthesiologists are used to give you the best possible experience. A consultation with Dr. Loeb prior to the procedure will give you the peace of mind you need before the big day arrives.

What types of anesthesia are used?

There are three categories of plastic surgery anesthesia used in Dr. Loeb’s procedures:

1. Local anesthesia: Local anesthesia refers to a pain medication that produces numbness wherever it is injected. This prevents pain and sensation in one particular area by blocking electrical impulses sent by the sensory nerves to the brain. The patient is awake and aware during the procedure, and able to breathe on his or her own. Memory and mental faculties are not affected at all. Local anesthetics may be topical (applied to the skin surface), sprayed (into the mouth, nose, or throat), subcutaneous (injected below the skin to numb nerve fibers), or regional (injected into the epidural space or a fluid-filled sac in the spine).
2. IV sedation (a.k.a. “Twilight” anesthesia): Potent medications are delivered through an IV to prevent pain and reduce anxiety. Often, sedation is combined with local anesthesia to enhance patient comfort. Patients become groggy and drift off to sleep, but continue to breathe normally on their own.
3. General anesthesia: Medications delivered through IV or gas mask cause complete loss of consciousness and pain prevention. A nurse or anesthesiologist operates a breathing machine during the entire procedure and monitors the patient’s heart rate, electrocardiogram, blood pressure, and oxygen levels. Amnesia is commonly experienced upon waking and the patient may feel groggy for the rest of the day.

Which cosmetic surgery anesthesia is right for me?

Sometimes choice of anesthetic boils down to the extent of the surgery. Each option has advantages and disadvantages, including differences in awareness, safety, side effects, and cost.

For instance, patients who are concerned about costs of plastic surgery in NYC may choose IV sedation for rhinoplasty. However, from a surgeon’s perspective, there are many drawbacks for IV sedation during a nose job. It’s a delicate balance achieving just the right dose of anesthetic to render the patient unconscious and motionless, without suppressing breathing. Sore muscles, a full bladder, or restlessness can all disturb the procedure. Without a breathing tube, blood can be aspirated into the lungs, which causes complications.

General anesthesia, on the other hand, is preferred in most cases. The airway is protected by a breathing tube and respiration is maintained by a ventilator. The depth of sedation is continually monitored and adjusted to keep blood pressure low, which reduces bruising, swelling, and bleeding for a better overall outcome. To minimize the likelihood of vomiting, we use narcotic-free general anesthesia.

Today it is unusual for a patient to undergo rhinoplasty with local sedation only. Simple rhinoplasty or revision of the tip, without correction of a deviated septum or sinus openings, may be appropriately done under local anesthesia with a mild sedative. Benefits of this method are that there is less grogginess for the rest of the day, minimized chance of nausea or vomiting, and no breathing suppression. Yet, surgeons prefer to have as few disturbances from patient movement as possible, which makes this type of sedation typically impractical for any extensive cosmetic work.

Popular procedures and plastic surgery anesthesia used:

1. Breast augmentation – General
2. Facelift – General
3. Brow lift – General or Local
4. Eyelid – General or Local
5. Rhinoplasty – General, Local, or IV Sedation
6. Tummy Tuck – General
7. Liposuction – General, Local, or IV Sedation
8. Arm lift – General
9. Thigh lift – General
10. Dermal fillers – Local
11. Chin implant – General or Local

Allergies to anesthesia

One concern is that a patient will be allergic to the plastic surgery anesthesia. These reactions range from a mild skin rash or hives to suppression of lung and heart function. We hear about tragic cases in the media from time to time, but the actual likelihood of a serious adverse event related to anesthesia is very rare.

Fox News reports that there are about 100 reactions for every 1.3 million patients put under anesthesia. Patients may be allergic to neuromuscular numbing agent drugs, Propofol, latex, or antibiotics. A trained anesthesiologist can spot the signs of a reaction and treat it before one’s health is ever in jeopardy.

Risk factors for allergic reactions to anesthesia include:

• Gender (female)
• Past reactions to penicillin or antibiotics
• Family history of reactions to drugs or anesthesia
• The presence of cross-reactive compounds (identified in a pre-screening skin test)
• Alcohol abusers, painkiller abusers, or smokers
• Heart, lung, or kidney problems

What questions should I ask about cosmetic surgery & anesthesia?

The American Society of Anesthesiologists classifies patients in the following ways:

• Class I: completely healthy
• Class II: mild controlled illness or disease with no interference in patient’s daily life
• Class III: illness or disease affecting more than two organ systems
• Class IV: expected to die within 24 hours of surgery
• Class V: organ donor

Class I and II patients are considered good candidates for surgery, while Class III patients may require additional assessments before proceeding – like urinalysis, hemoglobin tests, or electrocardiograms.

Dr. Loeb takes the pre-surgery consultation very seriously. This is not only a time to have all your concerns and questions about the procedure addressed, but also a time for Dr. Loeb to assess your health and determine if additional precautions need to be taken to ensure a success surgery.

How are risks of plastic surgery anesthesia minimized?

To minimize the risk of an adverse reaction, Dr. Loeb takes a three-prong approach:

1. Patient-Identified Lifestyle Choices: What sort of lifestyle do you lead? If you are a pack-a-day smoker who has had two heart attacks, you are probably not a good candidate for surgery. It is important that you are completely honest with the surgeon. There may be ways to still have the procedure done even if you do not lead the healthiest lifestyle, but the doctor has to know what situation he has before him.
2. Objective Testing: What does your doctor say about your health? An objective, independent evaluation is valuable in assessing the strength and function of your heart, lungs, and blood counts prior to surgery. A general internist should have a relationship with you and access to all past medical files to give us a reliable picture of your health over the years, so we can anticipate any potential problems that could arise.
3. Qualified Anesthesiologist: A certified anesthesiologist sits close to you in the operating room the entire time – monitoring your pulse, blood pressure, and respiration to make sure everything is going smoothly. Sophisticated computer equipment helps us keep a close eye on carbon dioxide and oxygen levels.

Contact Manhattan plastic surgeon Dr. Loeb at 212-327-3700 to schedule a consultation and have all your questions about plastic surgery anesthesia answered.

Resources:

1. RadiologyInfo – Anesthesia http://www.radiologyinfo.org/en/safety/index.cfm?pg=sfty_anesthesia
2. Fox News – Reactions to Anesthesia More Common Than Thought http://www.foxnews.com/health/2011/05/11/reactions-anesthesia-common-thought/
3. WebMD – Risks of Anesthesia & How To Prevent Them http://www.webmd.com/a-to-z-guides/anesthesia-risks-what-patients-should-know
4. ASPS – Anesthesia for Cosmetic Surgery http://www.plasticsurgery.org/Documents/medical-professionals/patient-safety-resources/Anesthesia_for_Cosmetic_Surgery.pdf
5. SheKnows – Anesthesia and plastic surgery: What you need to know http://www.sheknows.com/beauty-and-style/articles/810103/anesthesia-and-plastic-surgery-what-you-need-to-know