What is Safe Time to Be Under Anesthesia?

Question

Hello, I will be having surgery on 8/2/12, I'm concerned about the time my PS said I would be under 7.5 hours. He will be performing a tummy tuck with lipo to the tummy, lipo to the back and flanks, BA and BL. My lungs are a bit of a problem, I have a lot of scarring and have been under supervision from my pulmonary dr. it has taken him one year to clear this surgery. I will be having my procedure done in a hospital and will spend one night there after the surgery.

Ronald Schuster, MD · Answer

It sounds like you have significant lung problems. You should discuss this with a Pulmonologist. My guess is that it would be safest to break up your goals into two smaller procedures. Also, sometimes just a tummy tuck can tighten the tummy enough to make it more difficult to breath (it raises the diaphragm). Be prepared.

S. Larry Schlesinger, MD, FACS · Answer

7-1/2 hours for a young, healthy person to have the surgeries you are having sounds just about right to me. Unfortunately, Murphy's Law even applies to cosmetic surgery at times. I think your question is a good one to ask, and my recommendation is you give yourself a break, do the most important surgery first, maybe abdominoplasty and liposuction, recover for 6 months, and if all went great, go ahead and do the second surgery. You didn't get all that loose skin and fat in one day, therefore you don't have to get rid of it all in one day.

Richard J. Bruneteau, MD · Answer

The combination of tummy tuck, breast augmentation, breast
lift and liposuction can be performed in a single setting.  When these operations are performed together
safety has to be every ones first priority.

Your
history of pulmonary problems and an estimated surgical time of over 7.5 hours
is troubling.  Under these circumstances,
it might be appropriate to modify the surgical approach.  Either utilizing a surgical team to shorten
the intro-operative time or performing multiple smaller procedures may be more
appropriate.

We
believe that the length of the procedure should never exceed four to six
hours.  Complications from surgery
increase significantly when these numbers are exceeded.  An experienced surgeon and surgical team that
focuses on efficiency can minimize the length of the surgical procedure.  We often use another surgeon as a first
assistant to help with the process.

The
advantages of this approach are obvious and include improved synergy and harmony
which improves the overall aesthetic result. 
Patients experience one recovery rather than multiple recoveries and
they potentially save money when these procedures are done in combination.

Combination
surgery isn’t for everyone.  Some
patients like yourself have coexisting health problems which may prevent this
approach.  Meeting with a board certified
plastic surgeon will help sort this out and help formulate the best treatment
plan for you.  In some cases, it may not
be appropriate to undergo cosmetic surgery.

Jeffrey E. Schreiber, MD, FACS · Answer

As long as you're cleared by the appropriate doctors, you should be okay. However, if you have any concerns you may want to think about dividing your surgeries up into 2-3 sessions instead of one big one.

Camille Cash, MD · Answer

Safety is always the number one priority in surgery.  Generally the recommended limit for anesthesia for an elective cosmetic procedure is six hours.  I encourage you to discuss your concerns with your surgeon as well as the anesthesiologist.  It is important that you feel comfortable and confident as you prepare for surgery.

Paul Gill, MD · Answer

I am concerned about your pulmonary history.   I generally tell patients that if they are asking whether their medical problems allow cosmetic surgery to still be safe, they need to seriously consider the risk to benefits of a procedure.

	Without knowing your exact condition and severity, I cannot make recommendations to whether your procedure is appropriate or needs to be shortened.   I ask that you visit carefully with your physicians and even get a 2nd opinion to ensure that you are making the best decision.

	 

	I wish you a safe and healthy recovery.

	 

	Dr. Gill

C. Bob Basu, MD, MPH, FACS · Answer

Although combined procedures and general anesthesia for 6-8 hours are safe in healthy patients, I would need to know more about your pulmonary history.   This is important.  Over 6 hours of general anesthesia could have some effects on your pulmonary status.  If indeed you have a significant pulmonary history (which it sounds like if you are writing you have significant scarring in your lungs), them I would suggest reducing the length of your surgery.  Remember, this is elective surgery.  It is OK to come back and fight another day.  Talk to your pulmonologist and PS to develop a plan with which you are comfortable.

	Best of luck.

	Dr. Basu

	Houston, TX

Anire Okpaku, MD FACS · Answer

A 7.5 hour procedure on a sick patient is too long.  There are a couple of issues at work here.  The first is that 7.5 hrs is a long surgery for procedures that you are talking about having.  There are a good number of surgeons who can do it several hours quicker. How severe are your lung  issues?  Do you really want to jeopardize your life for this surgery?  Think about getting a second opinion.

	 

	Good luck,and thank you for the question.

	 

	Sincerely,

	 

	Anire Okpaku MD

Jason J. Hall, MD, FACS · Answer

You have to remember that this type of surgery is all voluntary, and that risking your life to have everything done at once isn't something I'd recommend that my patients do.

	If you've been cleared for surgery, I would suggest you pick one of the procedures that most concerns you and do that first, realizing that it may be the only one that you can do if any problems arise. Have it done in a hospital with your pulmonologist around to manage any lung problems after surgery.

	Remember, this type of surgery is totally elective and not worth dying over.  You don't want to be a headline.

	Hope this helps,

	Dr. Hall

Leonard T. Yu, MD · Answer

From your history, you would be wise to break up your surgery into at least two shorter procedures. You will probably recover faster than if one long procedure is done. This may cost more than doing one long procedure, but would be safer and less costly in the long run than if you had serious pulmonary problems post operatively.

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