But I don’t want to go under general anesthesia!

This is the second thing I hear from half of the women I meet. The first is a wish list of where they want the fat removed: from here, from there…and what do you think about the backs of my arms…and then, inevitably, about fifty percent of the time the next thing they say is: “but I don’t want to go under!”

For those of you who have knee-jerk-reaction fear of general anesthesia, I get it. You have obligations…young children, a job to go back to…and it freaks you out to think you’re risking your life for your vanity, and you figure if you can do it without “going under,” you’ll be safer.

I know I am not going to wipe out the general fear of “going under” with one blog. It’s like that thing that happened with the bagged spinach back in 2006. The E. Coli outbreak has long since been over but I still haven’t been able to bring myself to buy spinach in a bag.

But somebody needs to clear up the facts.

 So here goes:

The definition of general anesthesia is:

The absence of sensation and consciousness as induced by various anesthetic medications, given by inhalation or IV injection.

 (http://medical-dictionary.thefreedictionary.com/general+anesthesia)

(You can skip down to the red print if the following paragraph looks too boring and technical—you’ll still get the gist of it from the rest of the blog.)

The components of general anesthesia are analgesia (NO PAIN) amnesia (NO MEMORY), muscle relaxation, control of vital signs, and unconsciousness. The depth of anesthesia is planned to allow the surgical procedure to be performed without the patient’s experiencing pain, moving, or having any recall of the procedure. Endotracheal intubation or insertion of another artificial airway device and respiratory support are often necessary. General anesthesia may be administered only by an anesthesiologist with or without an anesthesia assistant or a Certified Registered Nurse Anesthetist.

 So, it is a fact that many of you have actually had general anesthesia and you don’t know it. You think you had something called “Twilight.”

 “Twilight” is not a technical term in the anesthesia dictionary. It is—besides being the biggest Vampire movie franchise of all time—a catchy marketing phrase that many cosmetic surgeons use to allay your fears about having “general anesthesia.”

 Newsflash: once you’re asleep on the table, you’re asleep. It doesn’t matter how you get to that state. Just because you didn’t have a breathing tube in and all you got was IV propofol/”the Michael Jackson drug” (which, by the way, there’s nothing wrong with, as long as someone’s watching you while you’re getting it) doesn’t mean you didn’t have “general anesthesia.”

In fact, the truth is that it is usually safer to have “the tube” monitored by an anesthesiologist, controlling your airway, than just the sedation alone, or what is being sold to you as “Twilight.” Because if you are basically asleep without an airway, and your reflexes are blunted, you are at increased risk for complications of aspiration of your own saliva (ie, aspiration pneumonia) and not getting enough oxygen.

Then the inevitable question:

But what about like in one of those movies—what if I wake up in the middle?

It’s not going to happen. Not in an accredited facility with a Board-Certified Anesthesiologist (the only way I practice surgery.) When you are under “general,” The anesthesiologist has all kinds of fancy state-of-the-art equipment to monitor exactly how “asleep” you are, and it is second nature to him to keep you at the perfect level of sleep.

So how long will I be under?

Those of you plastic surgery virgins are shocked when you find out that it’s probably going to be at least a few hours, because getting your gallbladder out only took twenty minutes. While it sounds scary that your cosmetic procedure, depending on the complexity, could require you to be “under” for as long as six hours, the thing is that, this is not like having six hours of heart surgery. The anesthesia you’re getting is not as “deep.”

And remember, you want your results as perfect and as even as possible, and you don’t want your plastic surgeon rushing, or having his partner or resident doing one breast while he’s doing the other. So it takes time.

Well, what about all those things I hear, about people dying from surgery and anesthesia?

And the subject of Kanye West’s mother invariably comes up.

It has been shown that Donda West’s unfortunate outcome was not due to the anesthesia or the surgery itself, but the fact that she had a pre-existing cardiac condition that was not addressed. And if you look into all of the other folklore about how “dangerous” general anesthesia is, you will see that almost all of those other stories have similar explanations. That is, not all of the I’s were dotted and T’s crossed before the surgery.

 So, what are the I’s and T’s?

In my practice, safety always comes first, and I am extremely OCD about this:

1)   Pre-op labs for everyone

2)   Electrocardiogram (EKG) for you’re over thirty-five, or have any history of ANY kind of cardiac issue.

3)   Chest X-Ray if you’re over fifty

4)   Medical Clearance by your internist if you’re over fifty

5)   Cardiac stress test if there is any question about cardiac disease

6)   You should be off any birth control pills or (if it doesn’t turn you into a monster) peri- and post-menopausal hormonal replacement since estrogen and progesterone can increase risks of blood clots (ie, pulmonary embolus and deep venous thrombosis.)

7)   Full past medical and surgical history, including family history of bleeding disorders, blood clotting disorders, or problems with general anesthesia.

8) STOP all recreational drugs (i.e., coke, ecstasy) at least two weeks before your procedure. I don’t judge, but you need to time your breast reduction/lipo/breast aug well around events like Coachella. You must know that these drugs can have serious interactions with anesthetic agents and need to be out of your system well before the surgery, and some of the “horror stories” you hear about reactions to general anesthesia are due to patients withholding information about what they do in their spare time.

I only work with board-certified anesthesiologists in fully-accredited facilities, where all of the resources and equipment are available to take care of any out-of-the ordinary issue that might arise, including the diagnosis and treatment of malignant hyperthermia (a rare condition with an incidence of 1/50,000 to 1/100,000), which is really the one and only thing that truly is a reaction from the anesthesia itself.

I’m not saying that there are zero risks. But there are not zero risks to walking out onto the street, either, and if nothing else, you should understand that, if you are healthy and not excessively overweight (and by that I mean morbidly obese, not just trying to lose that extra five to ten pounds), and all the I’s have been dotted and T’s crossed before the surgery, the risks of something happening to you because of the anesthesia are less than the risk of you getting in your car and driving home, and not just on the 405.

Perhaps the best testament to the safety of anesthesia is that those of us who work in “the business” (the business of plastic surgery, not entertainment, although I’ll be the first to admit, there’s kind of a grey area) are ready to jump on the table at a moment’s notice if there’s a procedure that we want to get done.

So, if nothing else, I hope that this blog has given you a little more perspective on the scary, ambiguous topic of “general anesthesia.” And if you have more questions, please come talk to us!

And if you saw theEmily Owens, MD pilot last night on the CW(I thought it was great—has a lot of potential :-))—don’t be scared by what they say. It sounds funny, but it’s not true that all  anesthesiologists are “former high school stoners.”

XO

LQ

9 comments
  1. Sandy said:

    I would like to know the truth about one thing…lol…do they give you the amnesia drug so you won’t remember something terrible happened in there….like…they let you wake up because you won’t remember the trauma anyway?

    • Sandy,
      I actually asked the anesthesiologist I worked with today about this because it is a good question. While I know that it is not to “hide” anything that has happened, I started wondering myself, “Why is it important for the patient to forget what happened before and after the surgery?” The benefit of this “retrograde amnesia” is that it keeps the patient calm for when he or she wakes up. There is more likelihood that the patient will remain calm after the surgery if they forget how nervous they were beforehand.
      Hope this is helpful!

      LQ

  2. Julia said:

    Hi there, this is a nice blog post, very informative. Thanks for posting it. Do you have any comments on patients who have soy allergies or other common food allergies and concerns about general anesthesia? Are there some drugs that are used for GA that should be avoided if food allergies are in play?
    Thanks!

    • Hi Julia!
      Glad you are finding the blog helpful! I wish I had more time to write posts and answer all the questions that come in, but this is a really good one. First of all, if you are ever searching the internet for an answer to a medical question, you should always look at the medical journal database, Pubmed (http://www.ncbi.nlm.nih.gov/pubmed). Not only is it the only place that you can find scientific information free of bias, but it prevents you from winding up in some chat room where you can be totally misinformed. You can read the article abstract summaries for free, and if there’s something you don’t understand, you can show it to your doctor, or ask him or her to search it with you if they don’t know the answer themselves. I do that with my patients when they come in asking about something I’ve never heard of, and it’s really helpful for both of us.

      Anyway, I did a little refresher course on Pubmed myself and basically confirmed what it sounds like you already know: Diprivan®/Propofol/the “Michael Jackson Drug” contains refined soybean oil and purified egg phosphatide. In an accredited facility or hospital the patient will be adequately screened in the pre-op area by the nurse and anesthesiologist for egg, soybean and nut allergies, so while the reaction could be life-threatening, it is uncommon. Propofol is usually used in the beginning of the anesthesia, and sometimes for the entire surgery if you are having “Twilight” but a Board-Certified Anesthesiologist should be able to manage without it. Just make sure you tell the OR staff about it when you get there!

      There have been other rare reports of reactions to anesthesia secondary to unknown causes, though one was thought to maybe be related to a gelatin allergy.

      Hope this was helpful! The link to the articles that I found in Pubmed is: http://www.ncbi.nlm.nih.gov/pubmed/?term=food+allergies+and+general+anesthesia

      XO
      LQ

  3. Julia said:

    Thank you! Yes, I’ve been doing a little digging on my own of Dr. Google, but I much prefer medical journals. Thanks for the link and the helpful info. I will bring my allergist’s report with me to my next pre-op consult.

  4. Dan said:

    Hi there… Please help me! I am scheduled for breast augmentation this month. I am a cocaine addict. I’ve been clean 1 week. It will be 3 weeks by surgery. Is that ok for general anesthetic? I’m healthy in all other areas… Besides this.

    • Danielle,
      I really am unable to give you advice regarding this since I have not seen you in consultation. The only thing I can tell you is that you need to discuss this with the anesthesiologist ahead of time (like
      ASAP) and be completely honest with him. Make sure that your surgeon knows as well.
      Best Regards,
      LQ

  5. Adam said:

    I love you. Thank you for putting some perspective into the quandary of general. I am a guy going under for lipo in a few weeks, and I will be sure to keep reading your comment every time I feel anxious about it.

    • Hi Adam,
      So glad you found this helpful! Let me know if you have any other specific questions before or after!
      XO
      LQ

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