Art of Anesthesia and Sedation in Cosmetic and Plastic Surgery
Several techniques can minimize the discomfort of the injection anesthetic. Skinnier needles enter the skin with less pain. A longer needle can reach a wider area requiring fewer skin punctures. Buffering the Lidocaine with a base can lessen the burning sensation that otherwise would occur. Slower injections hurt less.
Local Anesthesia with Sedation
Sedation is an alteration of your senses. Medications given through a vein will lessen your ability to perceive what you are going through. This includes a mixture of medications. With deep sedation, patients are sleeping deep enough to snore. The local anesthesia is injected after the sedation begins. Depending on the type of sedation, most do not remember the operation. Sedation takes some time to wear off. You will need a short period of observation after surgery as you recover. The observation is usually first in a recovery area and then either with a family member, nurse who we can help arrange, or on the ambulatory floor of a hospital. Do not plan much for the remaining part of the day as you recover.
Larger operations are usually done with general anesthesia where you are asleep during surgery. The anesthesiologist usually mixes several medications that are given through an intravenous line and others that you breath. A tube brings air through your mouth, back behind your throat and into your trachea (breathing pipe). Your body takes some time to recover from anesthesia. After surgery you will go to the recovery room and then to either a second stage recovery or to the floor. General anesthesia can be used on patients who leave the hospital the same day or stay overnight. Different medicines take different intervals to wear off. Some general anesthetic medications may take several days for all of the effects to have worn off. The back of your throat may be sore from the tube that was protecting the airway. This soreness usually goes away in a day or so.
Light General Anesthesia
Local anesthesia does the major work of comfort. The surgical field's nerves are blocked decreasing what is needed from the anesthetist. This means patients can be fully asleep during surgery yet wake with pain still controlled. Recovery is quicker, and with less risk of nausea.
Monitors and Safety
We watch our patient with several devices. Not all local anesthesia cases require all types of monitoring.
A finger or toe rests in a small warm clip that shows the level of oxygen in your body and your pulse. This pulse oximeter uses a red light that generates the small amount of heat. We try to keep you from moving this clip too much since it confuses the machine's pulse reading.
A blood pressure cuff around an arm or leg takes your blood pressure. Many machines are automatic reinflating the cuff every so often. The first measurement may have a higher pressure than the rest as the machine learns what range it must use for you.
A series of small pads on the chest or sides with wires attached connect to an electrocardiogram monitor. This more advanced monitoring is a more accurate way to follow a pulse than the pulse oximeter The EKG monitor also lets us see the electrical signals look like coming from the heart.
Serial Compression Device
We attach compression balloons that gently squeeze your lower legs during longer operations. Compression alternates with relaxation to minimize the risk of deep venous thrombosis DVT (blood clots in veins).
Plastic Surgery Specific Anesthetic Techniques
Dr. Bermant and his staff have evolved methods to maximize his patients' comfort. Explore some of his many procedures: