Mohs Surgery: Q&A
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General Anesthesia on a 91 Year Old Patient for Skin Graft After Mohs?
My 91 year old father needs a skin graft on his nose after mohs surgery. His mohs doctor will do this proceedure using local anesthesia, but most facial plastic surgeons I have spoke with want to do it under general anesthesia. Two questions... 1) is general anesthesia safe for a healthy 91 year old male? 2) Why will the mohs surgeon do it under local, but most plastic surgeons I spoke to do it with general anesthesia? Need t make a decision fast...any guidance is greatly appreciated!
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9 Doctor Answers |
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pachangaboy
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Mohs Surgery Uses Local Anesthesia
While general anesthesia is overall safe for patients who are healthy, like any medical intervention, it is not without some risk. One of the guiding principles of Mohs surgery is to perform a procedure that is minimally invasive. This translates to all aspects of the procedure including the use of anesthesia. Mohs surgeons use local anesthesia the vast majority of their repairs. Sedation might be considered in a few situations. if the patient cannot sit or lay still for the entire...
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Skin Grafts and Anesthesia
Most of the time, skin grafts just require local anesthesia. However, in extreme cases, sometimes general anesthesia can be used. Here are your answers:
1. General anesthesia is safe AS LONG AS he is very healthy! He will need to have an EKG before the procedure and be under careful view of the anesthesiologist. For patients who need a large or very in-depth skin graft sometimes it's nicer to be under anesthesia, especially if a patient (and bless them, but many elderly gentlemen get...
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General Anesthesia vs. Local Anesthesia
With regard to the first question, continued advances in general anesthesia have continued to improve its safety. However, the majority of reconstructive procedures after Mohs surgery can be performed safely under local anesthesia. Local anesthesia often seems to be the best option with regards to safety, recovery, ability to continue normal diet and medication regimen, and ability to drive oneself to and from the facility after many procedures. Not to confuse the picture...
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Dallas Plastic Surgeon
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General vs. Local Anesthesia
The ultimate goal is to maximize patient safety. You need a cooperative patient and great nursing to do these procedures under local anesthesia. The anesthesiologist also needs to be present to babysit the patient and to be available in case of an emergency. The risk is generally dictated by the overall health of your father. A preoperative evaluation by the anesthesia staff is probably a wise choice where you will be better educated on the risks and benefits of general vs. local anesthesia...
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General anesthesia not needed to do a graft
There is no question that general anesthesia has its place when doing larger reconstructive surgeries or for patients who simply cannot sit still for the reconstruction. However, when doing a graft in any patient at any age, general anesthesia is typically not warranted unless there is a very large site that requires repair (in which it would be potentially unsafe to use larger quantities of local anesthesia).
The beauty of Mohs surgery is that both the removal of the...
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General anesthesia for 91 year old after Mohs
Most anesthesiologists I have talked to swear that general anesthesia is just as safe as local with IV sedation nowadays. Certainly, the procedure will be more comfortable with some sedation than with local anesthesia only.
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Mohs surgery with local anesthesia
Mohs surgery in this patient would be very appropriate using local anesthesia and without general anesthesia. The advantage of this out patient procedure is that the risks associated with general anesthesia in a patient this age are minimized.
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Mohs Repair
Age is not a contraindication to general anesthesia. However, at 91, a thorough preoperative medical clearance is critical. Having said that, except for extreme circumstances (typically a very uncooperative patient) I perform both the Mohs surgery and repair (including skin grafts) in the office under local anesthesia. The differing opinions between plastic surgeons and mohs surgeons regarding local and general is likely a function of comfort and training. As a mohs surgeon our...
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Mohs Surgery under Local Anesthesia
Based on the information you gave, I would recommend doing this Mohs surgery under local anesthesia. One of the reasons your Mohs surgeon wants to use local, and not general anesthesia is because they are dermatologist and not surgeons. They do not have hospital privilages to operate in a hospital / outpatient setting. Since your father is 91, and I assume in relatively good health, local anesthesia is a reasonable option.
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