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General Anesthesia During Submentoplasty for People with Mild Cardiac Issues?

Is it safe to use general anesthesia during submentoplasty for someone with mild cardiac issues (mild arrhythmias and mild to moderate hypertension), but well-controlled with medication?

This patient had an EKG that was normal and has clearance to have the procedure from her PCP. She's just scared of general anesthesia. Her plastic surgeon (facial plastic surgeon/otolaryngologsit from a well-known teaching hospital) does most of his surgeries under general anesthesia, and insists that it's the best way for this patient. The main concern is the effects of the epinephrine used as the local anesthetic (high HR etc), in addition to the gases that are used under general anesthetic, that may exacerbate arrhythmias or heart issues. Can someone help us understand this better?

Doctor Answers (15)

Cardiology consultation, Preventative intraoperative measures

+2

For patients with cardiac issues, we like to obtain a preoperative consultation with a cardiologist. Usually this means that patients receive a stress test in addition to the usual preoperative tests. This can sometimes flush out problems preoperatively, rather than being surprised during surgery.

Depending on the arrythmia, there are specific intraoperative treatments that an anesthesiologist can administer to minimize the chance of an arrythmia.

No doubt the surgeon is contemplating a very light anesthetic. Light fast acting anesthetics when combined with local anesthesia and a solid preoperative evaluation should reduce the risks of surgery to a minimum.

I believe a cardiac patient is no safer under local anesthesia, and possibly much less safe, especially if they were to receive epinephrine without the watchful guidance of a board certified anesthesiologist and the blessing of a fine cardiologist.


Beverly Hills Plastic Surgeon
5.0 out of 5 stars 92 reviews

Cosmetic Surgery and General Anesthesia

+1

Actually, sounds like the surgeon prefers to do surgery with general anesthesia and they are obviously not comfortable doing some, all, or certain cosmetic procedures under local anesthesia.  A surgeon's comfort-zone determines their preference of anesthesia.  General anesthesia is easier on the surgeon but not necessarily the best choice for the patient.  New improvements in local anesthesia make cosmetic procedures more comfortable for patients as well as surgeons.  I personally perform all my facial cosmetic procedures under local anesthesia with great patient comfort.

Paul S. Howard, MD
Birmingham Plastic Surgeon
5.0 out of 5 stars 7 reviews

Chin liposuction under local anesthetic

+1

More often than not, I do this procedure under local anesthetic.  If the patient is anxious about this, some oral Valium really helps take the edge off. 

Allan J. Parungao, MD
Oak Brook Plastic Surgeon
4.5 out of 5 stars 12 reviews

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Look at your anesthesia options

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The anesthesia is an important consideration when it comes to your plastic surgery.  Safety is usually the first concern regardless of the type of anesthesia being considered. Look at all your options carefully.

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General anesthesia not necessary for neck/chin liposuction

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There is no reason to undergo general anesthesia for neck liposuction.  It can be done under local anesthesia with or without a bit of sedation.  It sounds like the cardiac risks are minimal, but it would still be advised to avoid general anesthesia, if you can.

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General Anesthesia For Neck Liposuction Not Necessary

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As the other physicians have mentioned, general anesthesia is not necessary.  Properly done IV sedation combined with local anesthesia is capable of providing a surgical experience that is completely painless and not remembered at all.  In addition to avoiding the potential cardiac complications, you will almost certainly avoid the nausea and cognitive impairment that many patients experience with general anesthesia.  In fact, the effects of IV sedation plus local anesthesia are sufficient to do all facial plastic surgeries including facelifts and rhinoplasties.

Local anesthesia by itself is also quite sufficient but you would need to endure a few minutes of pain as the shots are completed.  I rarely do surgeries without some IV sedation but on occasion have patients who really want to avoid all mind altering drugs and I will oblige them if it is clear that they understand the process.

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Liposuction of the neck is usually performed under local anesthesia.

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Regional neck surgery is commonly done with local anesthesia only.  Even though general anesthesia is extraordinarily safe, in patients who can endure a little bit of discomfort, the procedure can be performed under local only.

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These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.