ANESTHESIA FOR COSMETIC SURGERY
There are many aspects of cosmetic surgery that you will want to understand and discuss with an experienced plastic surgeon before choosing to have any procedure. One of the important aspects of cosmetic surgery that you will want to discuss with your surgeon is anesthesia.
When patients have surgery at our accredited, on-site surgical facility, PSI, patients can expect to have anesthesia delivered that meets AAAASF and Dr. Lapuerta’s strict standards as follows:
Who will provide my anesthesia?
Dr. Lapuerta only uses MEDICAL DOCTORS who SPECIALIZE IN ANESTHESIA. This means there is a doctor who is dedicated to your safety & comfort during pre-op, surgery and recovery. This allows Dr. Lapuerta to devote his entire focus to your surgical procedure.
Surgeons who provide their own anesthesia or use nurses or nurse anesthetists must divide their attention and responsibility between performing your surgery and over-seeing anesthesia as well.
Dr. Lapuerta has worked for more than 15 years with a select group of 5 medical anesthesia doctors who have extensive experience in outpatient anesthesia and anesthesia for plastic surgery in particular.
What type of anesthesia will be used?
Our surgical facility is accredited to offer the full range of anesthesia options that exist including:
Sedation/MAC (Monitored Anesthesia Care)
TIVA (Total Intravenous Anesthesia)
This allows for a custom plan to be developed for you based on your medical history, planned surgical procedures and your preferences. You will meet with your anesthesia doctor prior to surgery to discuss your options.
Will I be completely asleep and unaware during my procedure?
When amnesia is expected during surgery, the possibility of awareness is a common concern for patients before surgery. Awareness is a rare, but known, possible complication that occurs in approximately 1-2 cases per 1000.
Awareness tends to occur more often in patients with more serious medical history and patients undergoing trauma surgery, emergency c-sections and major cardiovascular surgery.
Thus patients having plastic surgery are less likely to experience recall or awareness. However, our facility uses the BIS monitor as an added measure to reduce the risk of awareness.
BIS Monitors are an advanced monitoring technique, rarely found in outpatient settings due to costs. A BIS monitor provides a patient’s EEG continuously during surgery and produces both a waveform and a number which helps the anesthesia doctor to identify the potential for awareness during surgery and make adjustments in anesthesia to reduce the chances of awareness during anesthesia.
BIS Monitors also allow for patients to receive levels of anesthesia that are more specifically tailored to their medical history and surgical procedures, providing the right amount anesthesia while reducing the potential for awareness during surgery.
What will be provided to control my pain after surgery?
Dr. Lapuerta uses local anesthesia in all of his surgeries. The use of local anesthesia blocks the transmission of pain from the surgical site to the brain and helps to reduce the need for narcotics and other anesthetics during and after surgery. This in turn can also help reduce the odds of nausea and vomiting after surgery.
Exparel is a fairly new form of local anesthesia used in some surgical procedures. Exparel is a local anesthesia that is injected during surgery and is released slowly over a three day period after surgery to provide superior post-surgical pain control. The use of Exparel also helps to reduce the need for oral pain medications including narcotics after surgery.
What is TIVA—Total Intravenous Anesthesia?
TIVA is a sophisticated method of general anesthesia that is rarely offered in outpatient settings due to increased costs and the need for an experienced anesthesia provider. Our office facility was the first in the Houston area to offer Propofol based TIVA for plastic surgery over 15 years ago. We offer TIVA at no additional anesthesia costs to our patients, who are appropriate candidates and desire this technique.
TIVA is a method of anesthesia whereby patients receive all of their anesthesia through an IV in their hand or arm. Often patients are sedated through medications in their IV and then an anesthetic gas is used to maintain patients anesthesia during surgery.
TIVA is a way to maintain anesthesia during surgery by using a continuous infusion of a drug, usually Propofol. Propofol offers many benefits, especially for out-patient plastic surgery.
Can be used to provide sedation or general anesthesia.
Has a side-effect property which is anti-nausea. This anti-nausea property is greater and more pronounced when more Propofol is given. Nausea and vomiting after plastic surgery can increase the risk of complications and reduce the potential for optimal outcomes. Anything that can be used to reduce complications, is a great benefit in plastic surgery anesthesia.
Can be used to provide anesthesia for any plastic surgical procedure.
Has a quick onset and wears off very quickly. This allows patients to recover quickly after surgery and frequently reduces the incidence of post-anesthesia “hang-over” & confusion.
Offers the greatest benefit for patient’s with a history of nausea and vomiting after surgery in the past, a history of severe motion sickness and patient’s undergoing certain surgical procedures associated with greater risk of nausea & vomiting.
Has no risk of triggering a genetic, potentially life-threatening condition known as Malignant Hyperthermia.
What is General Anesthesia?
General anesthesia is state of unconsciousness where patients no longer retain the reflex to protect their own airway. This means some patients, due to their medical history or planned surgical procedures, will require placement of a device to protect their airway.
General anesthesia can be provided and maintained by either a combination of IV drugs and anesthesia gas or by TIVA (Total Intravenous Anesthesia) where everything is given through the patients IV.
Both gas and TIVA methods are safe and reliable for outpatient plastic surgery. TIVA has many benefits discussed above, however, for many patients a Gas based general anesthesia may provide an equally successful outcome. Most patients who have had negative experiences in the past with general, gas based anesthesia, have received older generation inhaled (gas) anesthetics that had unpleasant side effects and produced prolonged “hangover” effects.
Desflurane/Suprane is the latest generation inhaled, gas anesthetic and has tremendous benefits compared to older options. It has a rapid onset and effect, wears off quickly, provides excellent anesthesia and allows patients to recover quickly with less side effects. Therefore, Desflurane/Suprane is a superior choice for outpatient plastic surgery. It is more expensive, however, our facility only uses Desflurane/Suprane for all inhaled (gas) based anesthetics we provide, at no additional costs to our patients.