Thank you for your question! I would advise you to speak to your plastic surgeon about any concerns you may have. Another alternative would be for her to have her procedure done under local anesthetic. Best of luck!
Dr Dhaval Patel
Double Board Certified
should be completely safe and I hope it went well for your grandmother. Surgery is scary but when done under local, risks are minimized.
These are great questions to pose to her primary care doctor and her anesthesiologist. Judging the risk of general anesthesia results in a risk range. Your grandmother would be considered fairly high risk given her age and prior history. Blepharoplasty is a much more straight forward and brief procedure so that might mitigate some of the risk. Local anesthesia in most cases is totally safe especially for a short procedure like blepharoplasty. This is an elective procedure so if you and your grandmother are unsure about the plan surgery can always be postponed or canceled. Your grandmother needs to be comfortable with the plan and potential risks. I hope this information is helpful for you.
Stephen Weber MD, FACS
Denver Facial Plastic Surgeon
In general, local anesthesia is extremely safe. You need to ask her internist or neurologist to get clearance. Also have you ask yourself how necessary is the procedure for her.
First of all, its important to have medical clearance by your primary care physician before undergoing elective surgery. This involves a thorough history and physical examination with review of all medications. A skin only upper blepharoplasty can be performed under local anesthesia without any sedation or general anesthesia.
I'm sure there must be a compelling reason to do an upper blepharoplasty on a 95 year old with significant health issues. Local anesthesia with anesthesic monitoring(MAC) and maybe some mild sedation should be the extent of anesthesia given. Fluctuating blood pressure, oxygen desaturation, the presence of anticoagulants which shouldn't be stopped due to the stroke history and the operative time are the enemies for this patient. A miniscule amount of epinephrine with the local shouldn't affect the blood pressure where a little high is better than a little low. The legs should be bent at the knees and graduated compression for the legs regardless of the length of surgery. I'm sure your plastic surgeon, the internal medicine team and the anesthesia team have all of this planned and more to prevent another stroke.
In our office, ALL procedures are performed under local anesthesia. Because of you grandmother's age, I would obtain medical clearance from her primary physician.
The safest method for facial surgery is local anesthesia. She can have an oral sedative to relax, but the main anesthetic is the injected local. The likelihood of any adverse event is significantly reduced by going with local only. Of course, she will be monitored throughout the case, even her mental status, by following commands etc. I wish you the best!
Having said that, I personally believe that she is much better off having very light intravenous sedation administered by an anesthetist or anesthesiologist in a hospital out patient surgery setting. These are generally part of the physical campus of the hospital or may actually be in the same building. As an example I use the UCLA outpatient surgery center. It has 15 operating rooms and while it is not physically part of the main hospital, there is a tremendous amount of resources immediately available should a medical issue arise. Many surgeons also have an accredited operating room in their office. I would not recommend surgery for a 95 year old be performed in an office accredited operating room simply because should a medical issue arise, there is very little help immediately available. The risk of the procedure is really related to her overall health. I think pain will be the most stressful aspect of surgery and local plus a small amount of intravenous sedation is a very helpful combination. Often when just local anesthesia is performed, there is no anesthesia personal monitoring the patient during the procedure. I think the extra personnel for her is helpful.
If your grandmother is having her eyelid surgery under local anesthesia only, there is a very low risk for cerebrovascular complications. The shorter the procedure and the less local needed, the better. Be sure to discuss with the surgeon all possible risks and complications associated with the procedure. Good luck!