Safety First: Experts Talk General, Local Anesthesia

Safety First: Experts Talk General, Local Anesthesia featured image
This article first appeared in the Winter 2024 issue of New Beauty. Click here to subscribe

For some of us, the scariest part of a surgery (cosmetic or otherwise) isn’t the hospital environment, the needles or even the potential for pain. Instead, the biggest concern is the very thing meant to relieve you of any discomfort or pain during surgery: anesthetic. Used for decades as an effective method to block pain signals, anesthesia has plenty of scary potential complications and horror stories to make anyone a little nervous about going under the knife. In fact, according to one 2016 study by The Saudi Journal of Anesthesia, a stunning 88% of subjects experienced pre-operative anxiety related to anesthesia.

Fort Myers, FL plastic surgeon Ralph R. Garramone explains that the reaction to anesthetic is typically at the forefront of conversations when discussing options with patients. “You have to approach every patient individually to understand what is best for them,” Dr. Garramone explains. “A patient may not want anesthetic or to go under the knife at all. They also may not have the downtime for it.”

Is Anesthesia Safe?

Like many medical practices, anesthesia hasn’t always been as safe as it is today. According to the Cleveland Health Clinic Anesthesiologist Christopher Troianos, MD death rates for anesthesia used to be as high as 1 in 20,000 back in the 1960s. Today, that number is around 1 in 200,000, with the chances of serious complication hovering around 1 percent.

Of course, that doesn’t mean that anesthesia is without risk.

According to the American Society of Anesthesiologists, factors like heart disease, lung conditions and kidney problems could all present complications while under general anesthetic, which is why a health assessment by an anesthesiologist is so important.

Serious complications that can follow from general anesthetic range from the mild (sore throat, numbness) to the potentially fatal. The presence of a board-certified anesthesiologist, who cares for and monitor patients under anesthetic is key to maintaining a safe environment

General Anesthesia vs. Local Anesthesia

While local anesthetic offers less risk, there are some procedures that cannot be effectively given under local or regional anesthetic. This can be due to the invasive nature of the surgery, as well as the precision, where movement from the patient could result in mistake or injury.

Because local anesthetic presents less risk, many procedures have been developed to be minimally invasive and require only local anesthetic. Everything from minimally invasive liposuction of the chin to the various mini-facelifts flooding the market
can be performed under local.

According to Scottsdale, AZ plastic surgeon, Robert G. Bonillas MD, FACS the appeal of these procedures often revolves around the anesthesia itself. “Many patients fear general anesthesia, and hesitate being put to sleep for any reason,” he says. “So the office environment and local anesthetic are requirements.”

That said, they need to maintain quality, clean environments. “Whether surgical procedures are performed under general anesthesia, monitored sedation or just local, safety should always be the primary concern,” explains La Jolla, CA plastic surgeon Robert Singer, MD. “They should only be performed in surgical facilities that are accredited by nationally recognized accrediting organizations like Quad A or in licensed hospitals.”

Minimizing Risk

Campbell, CA plastic surgeon R. Laurence Berkowitz, MD explains that practitioners that use anesthetic can mitigate risk in a few concrete ways. “You really want as many people in the room as you can,” he says. “Hospital environments are ideal because in the event of an emergency, there’s dozens of people who can be called on to provide aid. The anesthesiologist is your lifeguard, and I prefer to have two physicians in the room while operating.”

Having a board-certified anesthesiologist monitoring you is a key part of ensuring your own safety, and you can do more for yourself by ensuring you provide a detailed medical history to them, including any medications you are currently taking. The American Society of Anesthesologists recently released a warning regarding the risks associated with GLP-1 medications and anesthesia, suggesting you forego your daily or weekly dose before your procedure.

“Patient safety is of paramount importance in aesthetic plastic surgery,” explains Eugene, OR plastic surgeon Mark Jewell, MD. “Weight loss drugs such as Wegovy delay the emptying of the stomach, Patients must tell their plastic surgeon that they are taking this type of drugs and not take them for at least two weeks prior to surgery.”

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