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All About Surgical Anesthesia

When you’re considering any surgery, especially an elective cosmetic surgery, anesthesia may not be the first thing that you think about. You may be more preoccupied with preparing for your operation, your recovery and of course anticipating your result and how this will change how you look and feel about yourself.

That said, some of you who have been thinking about undergoing surgery for a long time might actually be anxious about the idea of “going under,” which is totally normal. Being put to sleep is kind of a strange idea to wrap your mind around.

In order to dispel any anxieties you might have about getting anesthesia, we sat down with our very own Toronto-based plastic surgeon, Dr. Austin, in order to get some insider info on everything there is to know about surgical anesthesia and to address any concerns that you might have.

What Types of Anesthesia Are Typically Used for Surgery?

There are three types of anesthesia that are used for surgery: local, regional, and general.

Local anesthesia numbs a particular part of your body, but you are otherwise awake during the procedure. We typically use local anesthesia for minor procedures like mole removals, or for non-surgical procedures like tattoo removal or even certain beauty treatments like getting lip fillers.

Local anesthesia is meant to ensure that you feel no discomfort during what are minimally invasive procedures. Local anesthesia is usually administered via injection or with a topical cream or numbing agent.

Regional anesthesia numbs a larger portion of your body, but again you are still awake during the procedure. So an epidural, most commonly used during childbirth, would be considered a type of regional anesthesia. We don’t really use regional anesthesia at The Plastic Surgery Clinic for the types of surgeries that we do.

The most common form of anesthesia that we use for our surgeries is general anesthesia. This is what you would call “going under” or “going to sleep.” General anesthesia is a combination of medications that renders you unconscious for the entire duration of your surgery. You can think of it as a cocktail of medications; you’ll be given medication for anxiety, pain, as well as medication that will take away some memory around the surgery, and of course sleep medication.

We use general anesthesia for the majority of our surgeries like breast augmentation, tummy tuck, liposuction etc. It’s usually administered through an intravenous line (IV), but sometimes it can also be administered through a breathing mask or tube. Once administered it usually takes only about 1-2 minutes to kick in.

Another type of anesthesia that we might use if you are a patient at The Plastic Surgery Clinic is sedation. With sedation we’ll give you medication to make you calm and to help with pain, but you’re still awake during the procedure. We sometimes use sedation for smaller procedures like an upper eyelid surgery or revision procedures.

Most people however opt for general anesthesia, and that’s what we’ll normally recommend. We can tailor your general anesthesia to your needs, making it lighter or heavier depending on the type of procedure you are undergoing, so we usually find that this gives patients the most optimal surgical experience.

How Long Should I Expect to be Under?

The anesthesiologist will keep you under for the duration of your surgery. Depending on the extent of your surgery this can range anywhere from 1-6 hours. There is an anesthesiologist in the operating room (OR) with our team during the entire procedure monitoring your progress and adjusting your medication throughout, so they can keep you under as long as is needed.

At The Plastic Surgery Clinic we limit the length of our surgeries to anywhere between 4 and 6 hours, but this is to minimize surgical risk and not because you can’t be under general anesthesia for longer.

Is There a Possibility that I Might Wake Up from General Anesthesia?

We get this question a lot from patients. It can happen, but it is extremely rare. This is something that has really been played up in TV and movies as something that happens more often than it actually does. Like I mentioned earlier, there is an anesthesiologist in the OR monitoring you at all times and continuously adjusting your medication to ensure that there is no chance of you waking up before you’re supposed to.

Are There Any Risks to Being Put Under Anesthesia?

The risks of going under general anesthesia have to do with your overall health status. So you are at a higher risk if you have heart problems or lung problems, but then you are generally at a higher risk for surgery as well. We take a thorough medical history and ensure that our patients are healthy enough to undergo surgery and anesthesia.

Other risks might be a reaction to some of the medications administered, sore throat, nausea and vomiting or injury to the teeth. When you go under general anesthesia you need to be intubated for oxygenation and ventilation; it’s really rare, but there is a small risk that an injury to the teeth might occur during intubation.

How Am I Monitored While Under General Anesthesia?

At The Plastic Surgery Clinic we have state-of-the-art anesthetic machines that monitor a variety of things such as your oxygen levels, your carbon dioxide levels, your blood pressure, heartbeat, oxygen saturation and breathing, heart rhythm, as well as your temperature. It’s the anesthesiologist’s job to constantly monitor your progress throughout your surgery and to continuously adjust and control your medication as needed.

How Should I Prepare for Surgical Anesthesia?

There’s no real prep for general anesthesia. It’s pretty much the same as surgical prep. We ask our patients to stop smoking a month before surgery and this is for two very important reasons. The first is for wound healing (smoking inhibits healing), and the second is so that your lungs and airway are not irritated when you go under general anesthesia. If your lungs and airway are irritated before you go under they will be overreactive and you risk going into bronchoconstriction or simply put spasms.

The other thing that’s super important is to be open and honest about any drugs you may be consuming, or if you’re a heavy drinker. The reason for this is that drugs and alcohol have a bearing on how you react to the medications that are given to you for your general anesthesia. So the doses you receive are dependent on whether or not you consume drugs or alcohol, when, and how much. We can’t stress enough how important it is that the anesthesiologist knows how to appropriately tailor your anesthetic.

We’re not here to judge—we’re here to make sure that your operation is as safe as possible.

Who Shouldn’t be Put Under General Anesthesia?

Anyone who is sick, has advanced cardiovascular or respiratory disease, shouldn’t undergo general anesthesia, but this applies to surgery as well. If you’re very sick we won’t operate on you.

At The Plastic Surgery Clinic we perform what is called an ASA (American Society of Anesthesiologists) risk assessment. An ASA risk score determines how healthy or unwell a patient is for surgery. We won’t perform a surgery on you if you are considered to be ASA 3 or 4. We only operate on patients who have an ASA score of 1 or 2.

If you want to learn more about how that scoring works, come in and talk to us! Our consultations are always free, and we’re here to answer any questions you may have to help you decide which options are best for you.

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