Is Nine Hours Under General Anesthesia Too Long?

Question

I am considering revision rhinoplasty and a facelift. The surgeon is a board certified facial plastic surgeon with excellent reputation. I am concerned about the length of the surgery. This will be done in a hospital. I am healthy, a non-smoker, and 46 years old.

Mike Majmundar, MD · Answer

Nine hours is a long time for surgery but it is performed commonly.  Before surgery, even if you are healthy, ask for the procedure to be performed at a hospital and plan on spending the night (know the fees in advance).  Make sure your primary care doctor is aware you are doing this so you have his/her blessing.  Sometimes prolonged anesthesia can make you feel fatigued and also have a prolonged 'hangover' effect into the next day so plan on having some help for  few days by someone who can stay with you.  Stock your fridge with soft foods and ice packs in advance.  Generally, a facelift and rhinoplasty together can also increase the amount of swelling for an individual, so give yourself some extra time for the swelling to resolve after surgery.

J. Jason Wendel, MD, FACS · Answer

Thank you for your question.

	 

	Having a surgery that long at a hospital is good.  Yes, surgery like this can take that long.  If you are worried, you can have the surgeries done separately. You can also ask to be observed in the hospital overnight to make sure that you recover as planned without any surprises.
	 

	Discuss these possibilites with your surgeon.  I hope this helps.

Toby Mayer, MD · Answer

A nose revision and full facelift takes 5possibly 6 hours normally.  It is safe to have 9 hours of anesthesia but that is way too long.

Kenneth D. Steinsapir, MD · Answer

Few would argue that your cosmetic surgery should not be life threatening. Generally anesthesia is associated with a finite risk of death. What is this risk? It depends on one's overall state of health and the relative risk of the procedure being performed. For a facelift, the risk of dying from having a general anesthesia is approximately one in 50,000 depending on the study. Recognize that studies the provide these estimates are very imprecise. Surgeries that go beyond 6 hours are associated with increased risks. How do ethical surgeons deal with this risk: we limit how much work we do at any given operative session. Rather than having one massive surgery-the Blue Plate Special, it is far safer to have two or three smaller surgeries. This achieves several things. First your cosmetic surgery does not push the bounds of survivability. Secondly how fresh do you think your surgeon will be at the start of the 8th hour of surgery? Finally, by having staged surgery, you can ease into your new look. Please do not be seduced by the promise of cost savings by having everything done at one time. I do also very much agree that additional opinions are warranted.

Shlomo Widder, MD · Answer

Dear philsfan,

	   In my practice I limit  surgeries to 6 hours. That is because , statisticaly , the complication rate increase significantly after 6 hours. Cosmetic surgery is purely elective and comlications should be reduced to a minimum. I would recommend to you to split the procedures into 2 separate times. You have to remember that doctors are humans too and after 6 hours they can get tired and less focused and the quality of work might not be the same. It might be inconvenient to have two separate procedure but safety and quality of work are more important. There were at least 2 celebrity cases lately that had very bad outcome after having very long surgeries. Play it safe and smart.

	                        Good luck,

	                                                 Dr Widder

J. Brian Boyd, MD · Answer

Some excellent surgeons are slow (they would say 'meticulous').

	The length of surgery  for an ASA Class I patient like you is not a major issue since body cavities will not be entered and the risks remain low.

	You should always have two or three consultations, however, before deciding to spend this kind of time with any surgeon!

William B. Rosenblatt, MD · Answer

I would be concerned about the surgeons skills. A face lift should take 2 to 3 hours and a revision nose no more than 2. Nine hours for elective cosmetic surgery is way too long.

Moneer Jaibaji, MD · Answer

This a difficult question. I agree with most of the back and forth arguments in this forum. My only concern here is what if the surgery lasted 10 or 12 hours. Are you still going to be safe. Can he/ she guarantee the surgery will finish in 9 hours.

Robert L. Kraft, MD, FACS · Answer

Nine hours is a long time to be under general anesthesia for cosmetic surgery.  You are young for a facelift so I would wonder what the surgeon proposes which would result in so long a procedure.  Whenever the anesthesia time exceeds 5.5-6 hours, there is a documented increase in complications no matter how skilled the surgeon and anesthesiologist.  I agree that, as a surgeon, you simply get tired past a certain point and it is important to recognize one's own limits and to create an operative setting with which both the patient and surgeon are comfortable.

Kris M. Reddy, MD, FACS · Answer

The Anesthesia time does seem excessive, and risks increase in conjunction with time under anesthesia. If the surgeon's safety record is good, then that will provide you some confidence. However, consult with 2 - 3 other surgeons to explore your options.

Is Nine Hours Under General Anesthesia Too Long?

Answers (16)

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