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CHAPTER 5 - ANESTHESIA FOR COSMETIC SURGERY
By Dr. James Gentile, Director of Anesthesia and Pain Management at North Fullerton Surgery Center, Montclair, New Jersey
Anesthesia for cosmetic surgery is similar to anesthesia administered for other types of surgery, but often shorter acting agents are used so they clear out from your system and allow you to go home the same day. People who have cosmetic surgical procedures are usually healthy, and since the surgery is purely elective, it is usually carried out under the best possible conditions in a comfortable environment. As a result, we put more emphasis on avoiding even minor inconveniences and small problems like bruising at the site of an intravenous line or beneath a blood pressure cuff.
Methods of blocking pain sensation from specific areas of the face and body have improved so much in recent years that most minor cosmetic procedures are done using some form of local anesthetic, with or without sedation. The specific choice of anesthesia depends on agreement between you, your surgeon, and the anesthesiologist. We may recommend the bare minimum type of anesthesia required to comfortably and successfully perform the procedure, but you may opt to have a higher level of anesthesia, and we will usually do so if it is reasonable.
Even if you have been given medical clearance for surgery by your medical doctor, the final decision to proceed with surgery actually rests in the hands of the anesthesiologist who will interview and examine you, as well as review your medical chart before the surgery. As all cosmetic surgery is elective, it does not make sense to proceed when your blood pressure is elevated or if you have signs of a viral syndrome or upper respiratory infection, no matter how inconvenient it may be to reschedule your surgery.
You may experience drowsiness and minor after-effects following anesthesia, including muscle aches, a sore throat and occasional dizziness or headaches. You may also have nausea, but vomiting is less common. These side effects usually improve rapidly in the hours following surgery, but it may take up to 24 hours before they are gone completely. New protocols are being developed to bring the incidence of nausea and vomiting down from 40% or more when untreated, to less than 5% incidence when treated.
Local Anesthesia
Local anesthetic agents temporarily prevent the nerves from carrying pain messages to your brain. During local anesthesia, you are awake and are thus able to communicate with the physician. An anesthesiologist is usually not present for procedures performed under local anesthesia.
Local anesthetics may be applied topically in the form of a gel, cream or spray and in this form may require application at least 30 minutes ahead of time to take effect. Local anesthetic may also be injected directly into the surgical area or around the main trunks of the nerves that carry sensation to the area.
Local anesthetics may be short acting and subside over the course of one hour or may be effective for up to six or eight hours. The choice of local anesthetics depends on the preference of the surgeon, and the procedure being performed, in terms of anticipated length of the surgery and which area of the body is being treated.
Twilight Anesthesia (Monitored Anesthesia Care)
Cosmetic procedures are often performed under twilight anesthesia, which is local anesthesia with the addition of a sedative medication given intravenously, such as Valium or Versed to provide you a more relaxed feeling. This type of anesthesia is usually chosen for procedures lasting longer than 1 hour, for a few minor procedures that are being performed in different body areas or when areas are being treated that cannot be well anesthetized with local anesthesia. The intravenous sedatives supplement the local anesthetic injections given by the plastic surgeon.
People who have intravenous sedation will feel drowsy and with the combination of sedation and local anesthesia they will certainly feel comfortable during the procedure. People who are given intravenous sedation in addition to local anesthesia will usually be monitored by an anesthesiologist so that the medication dose can be properly adjusted to keep you comfortable.
In the event that local anesthesia with sedation does not allow the surgical procedure to be carried out safely and comfortably, the anesthesiologist may switch to a general anesthetic.
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