I'm Afraid Of Going Under General Anesthesia?

Question

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.

Richard H. Tholen, MD, FACS · Answer

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

J. Timothy Katzen, MD, FACS · Answer

Thank you for questions regarding general anesthetic fears. This is a common fear. In my practice, I would say that this is probably the most common fear encountered before any plastic surgery procedure. First of all, if you want a full tummy tuck, you need general anesthesia. The reason you need general anesthesia is that the abdominal muscles need to be paralyzed for adequate muscle plication. This is impossible to do well under IV sedation alone. Therefore, if you want a tummy tuck, you will need general anesthesia. General anesthesia nowadays is very safe compared to previous generations.  Anesthesia has come a long way regarding the anesthetic themselves, and the way we can monitor patients. In my experience, I have never witnessed a case where a patient never woke up after anesthesia. I use board-certified anesthesiologist with years of training and years of private practice experience. I would suggest when you are seeking a tummy tuck to select an experienced, board-certified plastic surgeon who uses an accredited facility. I would also specifically request that a board-certified anesthesiologist deliver and monitor your anesthesia. Perhaps, you could even request from your plastic surgeon that you speak with the anesthesiologist before the surgery so some of your fears can be diminished. I hope that I have answered your questions regarding the fear of anesthesia. If you have any more questions regarding anesthesia during or after a tummy tuck, please contact my office. 
  
Sincerely,Dr. Katzen

Thomas Trevisani, MD · Answer

General Anesthesia is the safest method of Anesthesia - in my opinion- provided it is Administered by a Certified Anesthesia Provider, safe surgical setting, and of course provided patient is healthy and cleared to undergo surgical procedure.

Joshua D. Zuckerman, MD, FACS · Answer

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.

Vivek Bansal, MD · Answer

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.

Robert F. Centeno, MD, FACS · Answer

Thank you for your question. General anesthesia does have risks as any other procedure but is very safe.  Due to the improvement in medications, monitoring techniques and safety protocols, today it is as safe as flying in an airplane.  General anesthesia also allows your airway to be protected and monitored through out the procedure.  It is appropriate to do some procedures under local, some under local with sedation, and others require general anesthesia to keep you comfortable and safe.  Discuss your concerns with you surgeon and even seek a preop consultation with an anesthesiologist to improve your understanding of this part of your care.  Best wishes.

Miguel Delgado, MD · Answer

You are not alone, many people are fearful of anesthesia as there have been some horror stories in the news. But today with great advances in anesthesia it is very safe. In choosing your Board Certified surgeon, also ask questions about the anesthesiologist, make sure he/she is Board Certified. I have my own accredited surgery center and Board Certified Anesthesiologist who monitors the patients very closely and has a perfect safety record. Good luck.

Kenneth Hughes, MD · Answer

I perform about 1500 surgeries each year under general anesthesia, and I have not encountered a problem in this regard. A skilled and highly aware plastic surgeon in combination with a like minded anesthesiologist is the key in this situation. Find a plastic surgeon with ELITE credentials who performs hundreds of tummy tucks and liposuction procedures each year. Then look at the plastic surgeon's website before and after photo galleries to get a sense of who can deliver the results. Kenneth Hughes, MD Los Angeles, CA

Vincent N. Zubowicz, MD · Answer

It's more likely that you would be killed in a car accident on the way for your abdominoplasty and you would by an anesthetic catastrophe.

Eric Swanson, MD · Answer

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.

Don W. Griffin, MD · Answer

In young healthy people with no family history of anesthesia complications, general anesthesia carries very little risk. And even among the known risks of anesthesia, the situation where the anesthetics would prevent you from waking up for a long time is even more rare. I can't quote you statistics, but I can say that I have not heard of it happening in 16 years in the multiple surgery centers that I operate in.

	The procedure certainly can be done with an epidural block, and sedation, but I would bet that the risk of complications with this method is just as high or higher than the risk from a general anesthetic.

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