What is the Maximum Amount of Time You Can Be Safely Under with IV Sedation?

Question

I would like to have the following procedures done at one time.. Facelift Upper & Lower Blepharoplasty Rhinoplasty Ear Lobe repair (both lobes) Can this be done under IV sedation? Is it safe to have IV sedation for such a long period of time? Thanks...

Boris M. Ackerman, MD · Answer

Facelift combined with other procedures can definitely be safely  performed 
under IV sedation.  In our practice, the total length of procedure done under IV 
sedation is only slightly longer that general anesthesia.  It takes a skilled 
and experienced OR team – surgeon, anesthetist and OR staff to achieve this 
goal.  Most importantly, make sure that not only will you get the anesthesia you 
desire, but also the final surgical result as well.  Seek out an expert facelift 
surgeon, ask to see the before and after photos that depict all of the 
procedures that you desire.

Kenneth Hughes, MD · Answer

The studies have focused on general anesthesia, so this would be difficult to answer.   The main issue will be your comfort and your ability to keep your neck turned without becoming stiff and wanting to move.  Find a plastic surgeon with ELITE credentials who performs hundreds of 
facelifts, necklifts facelift revisions, and facial 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

Richard Parfitt, MD · Answer

I've performed thousands of facial cosmetic surgeries using IV sedation and the safety record of this type of anesthesia is remarkable.  I've had hundreds of cases where the same or a similar combination of procedures as yours has been done at one setting.  These cases can last 6 to 9 hours and the patients have tolerated IV sedation for this length of time quite easily.  There is some increased risk of nausea as the total dose of narcotic increases, but we find that if Ondansetron is given by mouth prior to induction and then used again soon after the IV is started, then once again as we near the end of a long procedure, then the incidence of nausea is minimal.If the level of sedation is monitored closely, patients remain asleep and continuously comfortable no matter how long the procedure.  IV sedation is much safer than general anesthesia and much less expensive as well.  The patient is able to protect their own airway and immediate reversal of the narcotic and versed can be accomplished with IV naloxone and/or Flumazenil/Romazicon.  I personally think it's completely unnecessary  and unjustifiably dangerous to stop a person's breathing, put a tube down their throat, paralyze the person and have a machine breathing for the patient when performing any type of facial cosmetic procedure.

Vincent N. Zubowicz, MD · Answer

I'm not sure there is a recommended limit IV sedation. After four hours the risk for infection with any operation starts to increase. If your facelift can be done considerably faster under general anesthesia I suggest you consider that as an alternative.

Michael I. Echavez, MD · Answer

There is not really a maximum amount of time that someone can be under IV sedation in terms of safety, but I would say there is in terms of comfort.  With only IV sedation, I find that most patients can tolerate a procedure for about 4-5 hours at most.  The procedures that you have listed would definitely take more than that amount of time, so I too would recommend a general anesthesia in your circumstance.

Steven J. Pearlman, MD, FACS · Answer

There are a number of reasons why most surgeons now prefer to do facelifts and nosejobs under general anesthesia, especially if both are being done together in the same sitting. After a few hours, patients get antsy and start to get backaches. But more importantly, even though patients think they want sedation, they still don't want to feel or hear anything. There is a fine line between sedation and fully asleep. Sometimes patients fight the drugs and require more sedation to make them comfortable, and end up not breathing well. This can be as a result of an usual opposite reaction to IV Valium, it becomes stimulating instead of sedating. Decreased breathing and Oxygen can be take care of by maneuvers such as holding the chin and putting what is called an airway between the teeth. However, there have been instances, especially in the news in NYC over the past few years when patients stopped breathing and couldn't be revived. Anesthesia was blamed, but every one of those cases were done under sedation and not general anesthesia. When under general anesthesia, patients are often still breathing on their own or assisted by the machine. Either way, an airway is already there, in case of an emergency there is always complete control of the airway.

Michael Law, MD · Answer

The safety of sedation depends on a patient and their health history. Plastic surgeons require blood tests, and sometimes other testing depending on a patients age and heath history. It is also important that a board-certified anesthesiologist administer the anesthesia.

William Portuese, MD · Answer

When performing a facelift, blepharoplasty and rhinoplasty it's probably best to undergo those procedures under general anesthesia and not IV sedation. It will be very difficult to sit still through the entire process and have conscious awareness of the procedure, especially the rhinoplasty. For patient safety and comfort we recommend general anesthesia for the above procedures. The length of time it takes to  perform those procedures is variable but it anticipated at least 5-6 hours at a minimum.

Stephen Weber MD, FACS · Answer

This depends on three factors - your health, the expeditiousness of your surgeon and the skill of the anesthesiologist or CRNA. In my training at University of Michigan, we could routinely perform this set of procedures on healthy patients under deep IV sedation. However, after practicing in several other settings after finishing training I have not found another group of anesthesia providers that can provide this level and length of sedation for the procedures you are planning to undergo even when the procedures are performed efficiently. For this reason, I currently recommend general anesthesia for healthy patients who are planning to undergo a series of procedures like you desire. I hope this information is helpful.Stephen Weber MD, FACSWeber Facial Plastic Surgery

Lisa Lynn Sowder, MD (retired) - Account Suspended · Answer

I would recommend general anesthetic for this combination of procedures which will take all day unless your surgeon is Speedy Gozales.  The LMA, which is a soft rubber form that sits in the back of your throat, has made general anestheia as an outpatient much more attractive.  The LMA itself does not require deep anesthesia to tolerate and the general anesthetic can be quite light when combines with some local anesthetic injection.  The LMA also allows excellent control of the airway which I think is super important, especially with facial procedures.  I used to do a lot of my facial surgery with sedation and local and now that my anesthesia staff has gotten so proficient with the LMA, I put almost all my paitients under general.  No pain, great airway control and easier on the surgeon and patient.  What's not to love?

What is the Maximum Amount of Time You Can Be Safely Under with IV Sedation?

Answers (10)

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