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

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
4.9 out of 5 stars 177 reviews

Cosmetic Surgery and General Anesthesia

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, FACS
Hoover Plastic Surgeon
5.0 out of 5 stars 7 reviews

Chin liposuction under local anesthetic

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
Chicago Plastic Surgeon
4.9 out of 5 stars 40 reviews

Chin and neck liposuction and anesthesia

There are less severe anesthesia options for chin and neck liposuction.  I would explore the safest option as discussed with your cardiologist or internist. 

Raffy Karamanoukian, MD, FACS
Los Angeles Plastic Surgeon
4.8 out of 5 stars 94 reviews

Look at your anesthesia options

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.

Mario Loomis, MD
Middletown Plastic Surgeon
4.4 out of 5 stars 7 reviews

Anesthesia for Chin Liposuction

If you are not having any other procedures at the same time, this procedure can easily be done with tumescent local anesthesia or mild sedation. Even if general anesthesia is something you are medically cleared for, if there is a safer alternative, that is always the best choice.

Roy A. David, MD
San Diego Facial Plastic Surgeon
4.5 out of 5 stars 23 reviews

General anesthesia not necessary for neck/chin liposuction

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.

Carmen Kavali, MD
Atlanta Plastic Surgeon
4.5 out of 5 stars 42 reviews

General Anesthesia For Neck Liposuction Not Necessary

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.

Louis W. Apostolakis, MD
Austin Facial Plastic Surgeon
4.9 out of 5 stars 30 reviews

Liposuction of the neck is usually performed under local anesthesia.

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.

Vincent N. Zubowicz, MD
Atlanta Plastic Surgeon
4.7 out of 5 stars 35 reviews

General anesthesia in a cardiac patient receiving liposuction

Liposuction of chin area is a very popular and effective procedure. Patients appreciate they are at newly renewed jaw line and the removal of heaviness from the lower part of her face. However, the most important factor to get a great result is the compliance of the patient after the surgery. In our practice, we routinely tell the patients that they must wear a compressive garment to this area 24 hours a day for the first two weeks. After this period, they must use this garment when they get home from work and throughout the evening. This is extremely important as this area of the body is very sensitive and to get a great result you want to make sure that the skin is thoroughly compressed against the underlying muscle to establish a smooth result without depressions or indentations.

Pat Pazmino, MD, FACS
Miami Plastic Surgeon
4.7 out of 5 stars 101 reviews

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.