Is IV sedation with Propofol during a lower eye bag surgery with fat transfer considered twilight sedation or general anesthesia

Question

I am confused about the specific differences between local and general anesthesia and all the different anesthesia options in between. There is something called a Twilight Sedation, which I read is "conscious" sedation, but I've read that some doctors use Propofol during Twilight, which is "unconscious" sedation and wouldn't it then be a lot stronger and different than a conscious sedation? Also, what would be the differences between IV sedation w/ Propofol and a full blown General Anesthesia?

Michael P. Morrissette, DDS, FACS · Answer

The term "twilight anesthesia" usually refers to an intravenous technique of sedation where the patient is given medication to make them relax and unaware of the surgery. There are many drugs that can be given, but most common drugs are Versed and Propofol and a narcotic. Unlike a complete general anesthetic, there is no breathing tube placed and the depth of anesthesia is less so patients generally recover much faster. The difference between a "conscious" sedation and "unconscious" sedation is a gray area. At the start of the surgery, the surgeon may want the patient in a deeper anesthetic while he administers local anesthetic. As the surgery nears the end, the patient may be in a lighter anesthetic and begin to be more aware of the surroundings. In either case, you want to be sure that the facility is an accredited surgery center and the person administering the anesthetic is licensed to do so. With cosmetic surgery, most surgeons are moving towards lighter anesthetic such as twilight anesthesia.

Brian K. Machida, MD, FACS · Answer

Propofol is used for initiation of general anesthesia prior to intubation. It is given IV and can be used for twilight. It is getting close. Usually once intimated, patients are switched to an inhalational anesthetic.

Johnson C. Lee, MD · Answer

Propofol can be used in both twilight sedation or general anesthesia. When used in lower concentrations, it works well as a sedation so that the patient is still arousable and able to breathe on their own. In greater concentrations it works as a general anesthesia once the patient no longer breathes on their own and requires ventilation. It is important to discuss the risks and benefits with your surgeon and anesthesiologists so there is an agreed plan on the type of anesthesia best for your case.
Johnson C. Lee, MD 
Board-Certified Plastic Surgeon

Mark L. Mazow, MD, FACS · Answer

You ask an excellent question. Sedation can be conscious or unconscious. Most conscious sedation is ether with oral medication or extremely light IV sedation.  If a patient is given IV sedation they are likely to lose consciousness at some point and in general this should be administered by a board certified Anesthesiologist or CRNA who can monitor the heart and breathing. A combination if IV anesthesia/sedation and carefully administered local anesthetic is a great way to perform most facial procedures especially around the eyes. The use of this combination allows for intraoperative adjustments to eyelid position  when the sedation is turned off, making the results much better and more predictable. Propafol is usually administered in a constant drip during this kind of anesthesia which is often referred to a "Twilight sleep". General anesthesia carries this one step further where the patient is rendered unconscious with these same medicines given at a higher dose followed by the insertion of a breathing tube which is hooked up to a ventilator during the surgery to support breathing. This is used in longer procedures and those in which cooperation is not required. The choice of which type of anesthetic is to be used should be discussed with your surgeon and geared toward the type of procedure you are having performed as well as your comfort level and general health status which can affect which type is best for you.

William Portuese, MD · Answer

IV sedation with  Propofol usually means you will be basically unconscious throughout the procedure. Most patients will also require to have a breathing tube in place to protect the airway. Conscious sedation made you have some recollection the procedure. Best to speak with your surgeon and anesthesiologist to clear up any confusion. In our practice, we place patients under general anesthesia for lower eyelid surgery. Upper eyelid surgery can be performed under local or general anesthesia, depending on the patient's desires

Bradford A. Bader, MD · Answer

There are only 3 types of anesthesia: 1) local - numbing medication injecting directly into area being operated on2) regional - numbing medication injected near nerves that supply sensation to the area being operated on3) general - various medications administered by mouth, IV or via inhalation that produce a whole body effectThere are a lot of terms that are used interchangeably and it can be confusing: conscious sedation, light sedation, moderate sedation, deep sedation, monitored anesthesia care (MAC). The thing to remember is that ALL of these are general anesthesia. The goals of general anesthesia are analgesia (don't feel it), amnesia (don't remember it) and immobility (don't move). To make it more confusing, there are 4 levels of general anesthesia. The level of general anesthesia desired is up to the judgment of the anesthesiologist and surgeon working as a team. They will select drugs that have various benefits towards achieving comfort and safety for the patient. Propofol is a great drug that is very safe as it is does not suppress breathing and muscle tone like many other drugs and wears off in a matter of minutes. I would recommend that you not get too caught up in all of the various terms and drugs. The most important questions to ask are who will be administering the anesthesia (anesthesiologist, nurse, surgeon) and in what setting (office, surgery center, hospital). You should ask about the risks involved and do not proceed if you are not comfortable with the answers you receive. I routinely perform the operation you are having in my office procedure room using propofol administered by a board-certified anesthesiologist. It can be done very safely and comfortably. Good luck.

Mehdi Sina, MD · Answer

Hi,Local anesthesia is just numbing of treatment area. If you cut your finger and needed stitches, you would get a shot of local anesthesia.Twilight or conscious sedation is deep relaxation. You are not asleep but you are not awake either. Medication is administered by an anesthesiologist but you maintain your own drive to breathe; thus you do not need a breathing tube. General anesthesia is when you are completely asleep and need a breathing tube. Many anesthesiologists consider this more safe than twilight because the airway is controlled and protected at all times.Best,

Michael Elam, MD (retired) · Answer

Dear Lisa, I would speak with your anesthesia provider and discuss the many different options available. The most important aspect of the anesthesia is who will be administering your anesthesia and what the setting is. You should have anesthesia administered by a board certified anesthesiologist or nurse anesthetist in a fully accredited operating facility. This will help ensure your comfort and safety. Best regards, Michael V. Elam, M.D.

Is IV sedation with Propofol during a lower eye bag surgery with fat transfer considered twilight sedation or general anesthesia

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