Anesthesia and plastic surgery: What you need to know

Aug 3, 2009 at 5:28 p.m. ET

For many people, the greatest concern when it comes to surgery is anesthesia. This is probably because one of our greatest fears is to have no control while our health and safety is in the hands of others. Our job as anesthesiologists is to help allay those fears by giving patients knowledge and guiding them through the surgical experience safely with minimal pain and discomfort. The following are some of the more common questions I have been asked by Dr. Fisher's patients along with some "need to know" information.

Woman Getting Injection

Anesthesia & plastic surgery

What you need to know about anesthesia

Who administers the anesthetic

First and foremost, you may have never asked yourself who will be putting you to sleep?

It's important to know who your anesthesia provider is. Not all anesthesia providers are created equal! Ask your surgeon who he or she works with to administer your anesthetic.

Not all anesthesiologists are created equal

Not all plastic surgeons utilize board certified anesthesiologists. Some work with non-certified anesthesiologists or nurse anesthetists. There is a marked difference between the two. Anesthesiologists are fully licensed doctors who have chosen to specialize in the area of anesthesiology. They must first obtain a bachelor's degree after four years of pre-medical studies then complete four years of medical school resulting in an M.D. or D.O. degree followed by a four-year anesthesiology residency program-for a total of twelve years.

Board certification is obtained when an anesthesiologist meets the American Board of Anesthesiology requirements and passes both written and oral examinations. Board certification is not a guarantee but is an indicator of competency and depth of knowledge. Anesthesiologists are doctors first, and then become specialists in anesthesiology.

By contrast, licensed nurse anesthetists obtain a bachelor's degree in nursing and then complete a two to three year nurse-anesthesia training program. One-year experience as an acute care nurse is mandatory.

Types of anesthesia

4 Kinds of anesthesia:

1. Local Anesthesia

Local anesthesia is used to prevent pain in a smaller, specific area. Examples of this are when a doctor injects an area to numb it before stitching a wound or when a dentist numbs you for a filling. During a straight local anesthetic the patient is awake. 

2. Intravenous Sedation

Intravenous sedation is when potent medications are given through an IV to help prevent pain and anxiety associated with medical and surgical procedures. Frequently, sedation is used in conjunction with a local anesthetic to provide the most comfort. With sedation, patients are usually very groggy and may briefly drift off to sleep. This is what people commonly call "twilight".

3. Regional Anesthesia

Regional anesthesia is when an anesthetic is injected around larger nerves to anesthetize/numb a larger area or region for surgery. A common example of this is when an anesthesiologist performs a spinal anesthetic or epidural for a C-section by injecting anesthesia near the spinal nerves which essentially anesthetizes the lower half of your body.

4. General Anesthesia

General anesthesia is when the patient goes completely to sleep for surgery. The patient is given medications, which cause loss of consciousness, and prevents pain. The medications are given intravenously or in combination with inhaled anesthesia gases. In plastic surgery this is the most common anesthetic you will likely encounter.

The type of anesthesia that you will need depends in large part on the kind of surgery you are having. With certain surgical procedures general anesthesia may be the only way for the patient to be completely pain free during the procedure.

questions to ask the anesthesiologist

It's important to ask your anesthesiologist whether you are having general vs. sedation. I frequently get told distressing stories by patients who said they "woke up" in the middle of a procedure and were scared this would happen again.

One explanation for this might be that the anesthesiologist did not communicated clearly to the patient that he never intended on putting them completely to sleep with a general anesthetic. His plan might have been sedation alone. In this case the patient coming in an out of consciousness could be expected. An example of where this might be the case is breast biopsies.

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