I'm Afraid Of Going Under General Anesthesia?

And I've been shopping around not so much as price but safety . i have this fear of going under General Anesthesia simply because i read that people sometimes NEVER WAKE UP AT ALL. and a girl on this form said it took her longer to wake up from surgery which scared the crap out of me.I live in philadelphia pa and i'm willing to travel to Califorina . I just so scared of going under deep anesthesia.If there's not need. I would like a full Tummy Tuck 1st.

Doctor Answers 18

Safe anesthesia and expert plastic surgery is available right there in Philadelphia!

In fact, traveling for surgery may introduce variables that make a "surgical vacation" an even LESS safe option. Normally, when I hear from a patient that "they read" some purported "fact" or another, I immediately consider that the patient may be inappropriately gullible, or simply distracted by an unreasonable (though very real) fear.

For example, my wife is an RN with over 35 years of ICU, recovery room, operating room, burn unit, and emergency room experience and skills who herself is "afraid" of anesthesia. Intellectually, she understands that anesthesia is incredibly safe, but still had an unfortunate "awareness event" during her own emergency C-section almost 30 years ago. Truly, hers is an irrational fear, but real nonetheless, as I surmise your is.
Still, if you want elective cosmetic surgery, you have to decide if your emotional fears can be overcome by information and facts that bring into focus the true risks of anesthesia.

"Delay waking up" can be as simple as decreased awareness during the immediate-post-op  recovery, due to amnesia-inducing drugs such as Valium and Versed. This amnesia lasts a few hours for most, but can last longer in others. Or it can be due to administration of a bit more anesthesia right before the end of the surgery, or slower metabolism of normal doses. In either case, your vital signs, including blood pressure, EKG, oxygen level in your tissues, expelled CO2, and even level of consciousness (BIS meter) can be followed by your anesthesia provider to ensure you are comfortably sedated and aware of your surroundings (conscious sedation or "twilight anesthesia"), mostly asleep but rousable (IV sedation), asleep but with spontaneous respiration and retained reflexes (MAC--monitored anesthesia care), or completely asleep and unaware but fully monitored and safe (General Anesthesia, including TIVA--total IV anesthesia).

The important fact (about the girl with delayed wake-up on this forum) you seem to have missed is the fact that SHE DID WAKE UP! Slower (than whose expectation?) wake-up does not mean the same thing as "almost died!" Patients' own anxieties, or family and loved ones' responses to the phrase "slow wake up" can also seem terrifying when in fact monitoring and support is continued until the patient IS AWAKE.

Drugs have certain rates of metabolism and breakdown (half-lives) and although you can certainly have rapid wake-up with short half-life anesthetic drugs, you also then get rapid awareness of pain! So that somewhat slower wake-up is actually planned in many cases, and might be different for different patients, especially those who might enjoy a few more than a few daily cocktails, beers, or bottles of wine!

So, there are lots of variables, and "deep" anesthesia is not needed for most cosmetic procedures. For more information about TIVA, which we utilize in our AAAASF-accredited office surgical facility, click on the web reference link below.

Also, just so you know, in the 26 years I have operated in our facility, we have performed over 16,000 operations without a single death, heart attack, or stroke. National statistics indicate that there are an average of 0.82 deaths per 100,000 inpatient surgeries, with males outnumbering females by a 2:1 ratio. Most of these deaths were in the elderly, and statistics are even better for outpatient procedures on young healthy patients.
Although you have a lower statistical risk of dying on the plane flight you are considering to California (1 death in 45 million flights), you have a significantly greater risk in the car ride from the airport to the hospital (1 death in 10,000 people per year). So stay local and reduce your greatest risk--the car ride to your surgery!
Choose an ABPS-certified plastic surgeon; all of us are required to operate only at accredited facilities with certified anesthesia providers, and do not fear anesthesia! But do wear your seat belt on your way to surgery! Best wishes! Dr. Tholen

Minneapolis Plastic Surgeon
4.9 out of 5 stars 255 reviews

Scared of general anesthesia

I get this comment all the time and more often in the past few years since people have started putting anecdotal stories on the internet. I completely understand the fear of going to sleep and leaving your life in another's hands. However, let me reassure you with the following.

The risk of general anesthesia(GA) in a hospital setting under a physician's care who is a board certified anesthesiologist is far less than the risk you take driving around in your car everyday and you are totally at the mercy of others on the roads. Thus you are more at risk driving to the hospital than under general anesthesia. In addition the risk of having a serious complication from deep vein thrombosis and a pulmonary embolism secondary to the tummy tuck , while low, is also much higher than the risk of GA.

The mortality risk from GA is based on your degree of health. For a healthy person under 50 the mortality riskin the setting noted above is around 1 in 500,000 to 1 in 800,000 and that would be from some freak accident. I have been in medicine for 25 years including internship and have only seen one such incident in a hospital I was working in and it occurred in a routine case which was sedation only, not GA, and was a drug reaction. It could have happened at home and does.

As for risks I tell my patients I am more comfortable with GA rather than sedation because their airway is protected and they have a doctor who is overseeing the case ( if your case is done in a hospital). To me that is more control and more safety compared to either (a) a nonhospital setting where there is only a nurse as the last person between you and God, or (b) sedation. Many patients over 40 and some under also have reflux which, if they are not under GA with their airway protected, can cause stomach contents to come up and be aspirated into their lungs and this create a caustic pneumonia which can be serious if not fatal.

This is not to say that sedation is not safe as long as it is not deep and your doctor is well versed in the management of these drugs. However, for significant cases like a tummy tuck, I would recommend GA.

I hope this helps and you don't let your fear keep you from something that could significantly help your self esteem.

Grady B. Core, MD
Birmingham Plastic Surgeon
4.6 out of 5 stars 12 reviews

General Anesthesia Fears

You probably know that general anesthesia is extremely safe, given that a patient is in good health and not of very advanced age.  But even though you may know your fears are not supported by statistics, it might not really help you feel more confident about "going under."

In our practice we use conscious sedation, also termed twilight anesthesia, for nearly all our procedures, including tummy tucks.  Note that this is not because general anesthesia isn't safe!  The strategy is based on our goal of enabling patients to avoid the side effects of general anesthesia, which can include extreme nausea, an uncomfortable level of grogginess that persists for a day or more and so on.  It has the added benefit of reassuring the patient since they are lightly asleep and breathing on their own, rather than being hooked up to a machine.

With twilight anesthesia our patients are unaware of the procedure being performed but they are not deeply "under."  Our M.D. anesthesiologist, who has worked with us for more than two decades, controls the level of sedation with a fine touch and monitors each patient very closely.  Patients wake up quickly and easily after surgery, with no general anesthesia "hangover."  You may want to see if there's a board certified plastic surgeon in your area who offers the same option.

Elliot Jacobs, M.D.
New York Plastic Surgeon

Elliot W. Jacobs, MD
New York Plastic Surgeon
4.5 out of 5 stars 35 reviews

I'm Afraid Of Going Under General Anesthesia?

Dear GS,

Thank you for your post.  There are quite a few people who are uncomfortable with going under general anesthesia, whether from fear of 'not waking up' or just because they are more concerned with nausea and vomiting, which can be a side effect of general anesthesia.  I offer general or 'twilight' anesthesia to my patients.  This is done by a board certified anesthesiologist.  Patients that are done under 'twilight' anesthesia wake up very quickly and feel better in my opinion.  You are still breathing on your own in this type of anesthesia but do not feel pain.  I supplement these patients with local anesthesia as well.

Best Wishes,

Pablo Prichard, MD

Pablo Prichard, MD
Phoenix Plastic Surgeon
5.0 out of 5 stars 48 reviews

Safety and general anesthesia

The risk of a young health adult having a problem with general anesthesia is in the 1 in 5 million range.   It is important to research who and where your general anesthetic is to be performed.  

  1. Board certified MD anesthesiologist is present
  2. Certified outpatient surgery center or AAAASF accredited office surgery facility

No plastic surgeon is looking for excitement in the OR.  It is a very controlled environment and every precaution is taken to be sure that you are a good candidate for the surgical procedure and the proposed anesthetic.  Safety is job one.   

Jeffrey Zwiren, MD
Atlanta Plastic Surgeon
4.5 out of 5 stars 19 reviews

Afraid of Anesthesia

It's not uncommon to hear some patients fear anesthesia. Only stories with complications get reported, which are far and few, and not the countless operations that go perfectly. The bottom line it do your homework. Make sure you're going to a Board Certified Plastic Surgeon and a licensed CRNA or M.D.. Period. They should be able to help you put your fears aside. 

Jeffrey Hartog, MD
Orlando Plastic Surgeon
4.5 out of 5 stars 60 reviews

All general anesthesia is not the same. Total IV anesthesia has advantages.

You are not alone.  When I see medical and nursing professionals in consultation they often ask as many questions about the anesthesia as they do about the surgery.  They recognize that this is a very important consideration.  Traditionally, a general endotracheal anesthetic is used for tummy tucks.  This involves gas, intubation, paralysis, and mechanical ventilation.  Total IV anesthesia avoids each of these unnecessary steps, making the anesthetic extremely safe (patients breathe on their own during surgery but they are asleep).  Patients wake up quickly and are less likely to experience nausea.  It is possible that this newer type of anesthetic may also help reduce the risk of blood clots forming in the legs by avoiding muscle paralysis and prone patient positioning during surgery.  Excellent question.  I've attached a link to this part of my website in case you wish to read more.  There is always an element of risk in surgery.  Our job is to make it as safe as possible.  Also, surgeon experience is very important.

Eric Swanson, MD
Kansas City Plastic Surgeon
4.7 out of 5 stars 58 reviews

General anesthesia safety

Thank you for your question.  In the hands of a board-certified anesthesiologist, at a properly AAAASF-accredited surgical facility, general anesthesia in a healthy patient is incredibly safe and effective.  As I tell my patients, you are never monitored more closely, or cared for more attentively, than in the operating room under anesthesia.

Joshua D. Zuckerman, MD, FACS
New York Plastic Surgeon
5.0 out of 5 stars 23 reviews

I'm Afraid Of Going Under General Anesthesia?

Your concerns about undergoing surgery/anesthesia are understandable and very common  Assuming you have chosen your plastic surgeon carefully and he/she works with well experienced anesthesia providers in a fully accredited surgery center the chances of you having a anesthesia related complication are very small.  Of course, your past medical and surgical history should be carefully evaluated as well. Based on your question and the ( almost palpable) anxiety,  I think that you will be best off spending additional time with your plastic surgeon discussing your specific concerns. You should be aware that, generally speaking, patients who are relatively calm prior to surgery tend to do well afterwards as well. Best wishes.

Tom J. Pousti, MD, FACS
San Diego Plastic Surgeon
5.0 out of 5 stars 1,499 reviews

Afraid Of Going Under General Anesthesia?

Thank you for your question. General anesthesia is so much safer today than even 10 years ago.  The gases are much more predictable than before.  A general is very safe, and in nearly 20 years of surgery experience, I have never seen someone not wake up.  That said, if you are still not feeling safe, have the procedure done at the hospital and get a spinal anesthetic.   I hope this helps.

Vivek Bansal, MD
Danville Plastic Surgeon
4.9 out of 5 stars 26 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.