Is paralysis required as part of anesthesia for a tummy tuck?

Question

I am 5'4 147 and having a "Mommy Makeover" My biggest fear is being that one person in a million who becomes aware during surgery but unable to move. I have heard that this is closely monitored but have also read that it is actually not always detectable if the patient is in distress. So I worry that there might not actually be any signs to alert the anesthesiologist and that the surgery could be unbearably traumatic. I have known someone who had this happen during a surgery years ago. Paranoid

Edwin C. Pound, III, MD · Answer

I have been doing surgery for over 26 years in private practice and I have NEVER had anyone wake up on the table.   While muscle relaxers may be used for better tightening of your stomach muscles during the surgery, you are not paralyzed.  I think a lot of this fear is just urban myth.  As long as your surgery is performed by a reputable, board-certified plastic surgeon in an accredited facility, you should do fine.

Janet Turkle, MD · Answer

Please be assured that a board certified Anesthesiologist working in a certified facility will have multiple monitors to alert him/her of your level of sedation. The BIS monitor will give a very clear indication of your level of sedation (lack of awareness!). The heart monitor, CO2 monitor, etc are also very indicative of how you are doing as well. Paralysis for the very brief period while the diastasis (space between the rectus muscles) is repaired is helpful in reducing tension and making this easier to perform. Please have a conversation with your surgeon and anesthesiologist about your conerns

Nelson Castillo, MD · Answer

Thank you for sharing your question and I can understand your anxiety.  In answer to your question most often paralytic are used during TT to allow for the muscle repair/plication portion of the procedure.  This step is important for achieving a nice outcome.  As for your fears, anesthesia supplied by board certified physicians is very safe and awareness is far less likely with the monitoring supplied with general anesthesia.  Talk to your surgeon about your concerns, they can provide the best reassurances.

Gary Lawton, MD, FACS · Answer

The patients are asleep with brain wave monitoring during general anesthesia in our facility.  Anesthesia awareness is avoidable using the best techniques. Paralysis is in fact important.  Even if you were not paralyzed but having anesthesia awareness, you would not be able to alert the anesthesiologist.  Your blood pressure, brain wave monitoring, pulse and other variables are used to titrate your anesthesia to your needs.

Kenneth Hughes, MD · Answer

Paralytics do not necessarily have to be used when tightening the abdominal wall.Kenneth Hughes, MDLos Angeles, CA

James E. Hardy, MD · Answer

Hi and thanks for the question. The situation that you are referring to is very rare. In most cases the patient can be paralyzed for only a short period of time or not at all. Talk to your ps about these concerns. You can also talk directly to your anesthesia provider ahead of time to make sure that your are comfortable with the way that your operation will be performed. Best of Luck - Dr. Hardy...

Scott D. Green, MD · Answer

The answer to your question is a simple one. No, paralytics are not required for a tummy tuck.   While tummy tucks are generally performed under general Anastasia with some temporary paralytics used during the tightening of the muscles this is not always necessary. Tummy tucks can also be performed under spinal anesthesia where the patient is more awake and alert similar to a C-section,  and they can even be performed under IV sedation.  This is a little more challenging for the surgeon but certainly both of these are acceptable methods of performing a tummy tuck and should yield similar results two other methods.  Hope this helps, and best of luck.

Robert S. Houser, DO · Answer

No, you don't need to be paralyzed. I perform abdominoplasties under epidural anesthesia and have no problem tightening the abdominal wall. Many others use an airway called an LMA and those patients aren't paralyzed either. Talk to your surgeon and the anesthesia provider about your concerns. If they say it "has" to be used, you don't necessarily need to change surgeons, they are just not very open minded. Overall, you'll be very safe and likely will not have any problems either way. Good luck!!

Tom J. Pousti, MD · Answer

In my practice, tummy tuck procedures are performed in an outpatient surgical facility with anesthesia provided by well experienced board-certified anesthesiologists. Generally, paralysis is utilized during the procedure;  these medications are helpful when it comes to providing for muscle "relaxation",  especially useful during the muscle plication portion of the procedure. Although some anxiety regarding surgery and anesthesia is to be expected, patients find that they did “get worked up for nothing” after their recovery is completed.  Most patients describe the experience of anesthesia as a "pleasant nap".
  Again, generally speaking, anxiety prior to surgery is very normal; its complete elimination is usually not possible. Assuming you have chosen your plastic surgeon carefully, other important "variables" such as anesthesia provider and surgery facility will be selected based on everyone's first priority: safety. This careful selection should give you some peace of mind that you will be safe around the time of surgery.  With this careful selection of plastic surgeon, it  is most likely that you will not be that "one in 1 million"...
Discuss your specific areas of concerns with your plastic surgeon who will be in the best position to help you calm your nerves.  I ask my patients to try to be as calm as possible prior to surgery; this “calmness" tends to translate to a smoother postoperative course. You may be able to alleviate some pre operative anxiety with music, exercise, meditation, a glass of wine (if ok with your surgeon), and positive/objective focus on the long term outcome/benefits etc. prior to your procedure.
 
I hope this helps.

Is paralysis required as part of anesthesia for a tummy tuck?

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