Anesthesia Options In Liposuction Surgery

Your Choices In Anesthesia
Although not all surgeons may offer you a choice in the type of anesthesia that will be used for your procedure, some do.  Even if your surgeon prefers one anesthesia type over another, it is important to understand how anesthesia works and which type of drugs are used, and how they may affect you.  There are varying degrees of consciousness which are achieved with certain anesthetics.  There are also several types of delivery systems, from oral, to gaseous, to intravenous (IV) sedation.  There are also topical, local and regional (nerve blocks) anesthetic methods which may be used in conjunction with gaseous and IV during your liposuction procedure. Lighter forms of anesthesia may be used during small, in-office revisions or procedures.

• Topical Anesthetics
  Topical anesthetics, such as Eutectic mixture of local anesthetics (EMLA), are rarely used in surgical liposuction procedures, but are sometimes used in injectable fat ablation procedures, such as with Lipodissolve.  EMLA provides an anesthetic (often llidocaine, benzocaine, or prilocaine) to numb the skin surface using a cream, aerosol/spray, gel, etc. delivery agent.  The cream is simply applied to the treatment area with a wooden depressor, or swab, or even a gloved hand, and the anesthetic takes about 45 minutes to reach its peak of effectiveness.  It is doubtful you will use a topical for any liposuction procedures (except for Lipodissolve).  Although this anesthetic is in topical form and may seem very simple, it is not without its risks. Improper use, such as excessive product usage over large areas of the body during one sitting, or covering the topical anesthetic (such as with plastic wrap) to increase its effectiveness is not recommended and can result in serious injury, or death in some cases. Use as directed.
• Local Anesthetics
  If you have ever had an injection to numb the immediate area of your body, you have had a local anesthetic.  Anesthetics such as lidocaine or xylocaine are almost always used in conjunction with epinephrine for liposuction procedures. The epinephrine narrows the bore of the blood vessel which in turn prohibits much bloodloss and helps minimize the amount of anesthetic that enters your blood stream. Local anesthetics are used in combination with IV sedation or even gaseous sedation for liposuction.  Local anesthesia only may also be used for in-office procedures such as micro-lipo, or finesse liposuction.
• Conscious Sedation, or Twilight Anesthesia (Intravenous (IV) Sedation)
  Twilight Anesthesia, is commonly used for liposuction surgery.  Anesthetics such as Versed (midazolam), Diprivan (propofol)  are delivered directly into the bloodstream along with a saline bag by the use of an IV catheter.  It only takes a few seconds for the anesthetics to take effect.  If the amount of anesthetics given are light enough, the doctor is actually able to give you instructions (such as moving to one side) yet you feel sleepy and relaxed. You will not feel any pain but are not rendered completely unconscious such as with General Anesthesia and are able to breathe on your own.  However, depending upon the amount, you may not move much at all, or be conscious of anything.  Discuss with your surgeon the level of consciousness you will have.
• General Anesthesia
  General anesthesia is also common in liposuction surgery.  General Anesthesia uses a combination of medications either intravenously or via gas you will breathe during surgery. General gaseous sedation is administered via a tube down your throat and also with a medication which will be delivered via an IV, depending upon your needs.  The tube will keep the airway open and free and clear and your breathing is monitored and stable.  You will be intubated after receiving Twilight IV sedation so that you are unaware of the intubation procedure.  You will only fall asleep and wake up just as you were when you were put under, unaware of the entire process.  General sometimes causes nausea post-operatively, however there are medications which care administered either beforehand or during to alleviate most patients of their nausea.

What Does Anesthesia Feel Like?
Some patients experience anxiety before, so please tell your anesthesiologist if you are feel this way.  Medications can be administered, or you may be given a prescription or medications to take before you ever get to the surgery center.  After being administered medications it will feel as though you are very sleepy.  You may also feel loopy, humorous and say funny things you may be reminded of later.  This is all the better, as you should see your surgery as a positive experience and nothing to fear.  You are in great hands with your surgical team and they will care for you from beginning to end.

Recovery From Anesthesia
Your recovery and any side effects (such as nausea) depends upon your own body and if any medications were given to counteract the nausea.  Normal recovery includes sleepiness, amnesia, lethargy and generally a relaxed state.  If you become nauseated, it should not last very long.  The aftereffects of anesthesia may last up to a week, although the nausea normally resides in just a few hours.

You will find that you don't remember much about when you woke up and the first few days of recovery. This is normal and is actually a plus in passing of the downtime.  Many patients find it difficult to take it easy, but know that it is very important that you set aside time from work and household responsibilities to give your body adequate time to heal.

Risks Of Anesthesia
Anesthesia is not without its risks.  It is very important to disclose all prescriptions, over the counter (OTC) medications and any supplements you may be taking or have been taking in the last 2 months.  It is also very important to disclose any pre-existing diseases or disorders, or any family history of diseases or disorders.  Tobacco use (nicotine patches and Vapor Cigarettes included), alcohol consumption, and any illegal drug usage must also be disclosed.

These inherent risks of undergoing anesthesia may include, most listed are related to gaseous state anesthesia):

• Lidocaine toxity
• laryngospasm
• bronchospasm
• aspiration
• intubation injury
• pulmonary edema
• respiratory arrest
• asthma flare-up
• Cardiovascular complications may include:
  • myocardial ischemia/infarction
  • myocardial ischemia
  • myocardial infarction
  • cardiac failure
  • cardiac arrest
  • hypotension.
• hereditary disorders
  • malignant hypothermia: Malignant hyperthermia (or hyperpyrexia) is when a patient's temperature rises rapidly (105F and above) when anesthetized with inhaled general anesthetics and can be fatal if not treated immediately and adequately.  This disorder is inherited and is sometimes unknown if other family members have never been anesthetized under general.  Patients should advise their surgeon and anesthesiologist of any unexplained deaths in their family while the patient was under anesthesia. This disorder is very rare (between 1 occurrence in 5000 to 1 occurrence in 100,000 patients) but there are tests which can help determine if you are at risk.

Smoking Tobacco & Illegal Substances

"- Smoking increases risk of airway irritability, bronchospasm, or cough during sedation. "Adapted from the American Society of Anesthesiologists; Guidelines on Sedation and analgesia by Non-Anesthesiologists, source: www.GasNet.org