White Coat Syndrome - Beta Blockers or Valium with General Anesthesia

Question

Bleph was cancelled twice- blood pressure was 170/100. At home -110/68, even 93/65 (taking Micardis HCT daily). Dr prescribed beta-blocker (Bystolic 2.5 mg) to start 2 weeks before next appt. Afraid with beta blockers blood pressure will go too low. Taking Micardis HCT 40/12.5, Simvastatin 10 mg and Zoloft 75mg daily. Dr suggested Xanax before surgery. Xanax doesn’t work for me. I do better on Valium. He said Valium remains in system longer & is dangerous before General Anesthesia. HELP!!!

Dilip D. Madnani, MD, FACS · Answer

You do have other options as opposed to going under general anesthesia. I perform blepharplasties under local anesthesia using valium and a pain pill. The procedure is comfortable and over before you know it. I have never had to cancel one due to increased BP as usually the valium takes care of nerves. Discuss this option with your surgeon or find another one who would consider this. There are multiple options for sedation and anesthesia and surgeons will do what they are comfortable with and what works best in their hands. Hope this helps.

Nelson Lee Novick, MD · Answer

Perhaps the "white coat syndrome" can be circumvented altogether via the use of nonsurgical rejuvenation techniques that necessitate local anesthesia at most..When we speak of rejuvenating the eye unit, we are talking about all the aesthetically important areas that surround the eyes, namely the upper and lower lids (including the upper cheek region immediately below the lower lids); the brows; the periorbital area to the sides of the eyes; and glabella area between the eyebrows. Today, happily, each of these regions may be improved nonsurgically (i.e. without cutting, stitches or prolonged healing and downtime and decreased likelihood of the "white coat syndrome."). Naturally, in the absence of photos or a clearer picture of what your specific needs are, I can only make some general comments about eye unit rejuvenation goals that can be achieved nonsurgically.  For example, a few microdroplets of Botox or other neuromodulator (such as Dysport or Xeomin) placed in the crow's feet area would quickly and significantly diminish those troubling wrinkles seen upon smiling. An additional droplet placed in the outer border of the eyebrow would help to not only lift and reposition the slight downturning seen there, but might secondarily benefit the incipient drooping of the lateral upper eyelids noted. Prominent malar creases below the eyes can be improved significantly with the use of a volumizing filler, such as Perlane L to eliminate the crease and round the cheek more (which will likely have the secondary benefit of improving the upper portion of the smile lines, without the need for injecting them directly). Under eye bags, dark circles and tear troughs and hollows above the upper lids are also amenable to improvement with injectable fillers. Consultation with a board certified aesthetic core physician with extensive experience in nonsurgical rejuvenation techniques would be strongly advised so that a specific treatment plan can be formulated.

Kenneth D. Steinsapir, MD · Answer

Eyelid surgery is elective.  It is best performed under local with mild intravenous sedation.  If you need generally anesthesia because you are so nervous and anxious about surgery perhaps you could decide not to bother with your eyelids.  I personal do not understand why your surgery cancelled for the blood pressure you had.  This can often be managed by the anesthesiologist right at the time of surgery with excellent results.  Perhaps there is more going on here than you realize?

White Coat Syndrome - Beta Blockers or Valium with General Anesthesia

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White Coat Syndrome - Beta Blockers or Valium with General Anesthesia

Answers (3)

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Our mission is to create a world where every investment in modern beauty is Worth It.