Is TIVA or General Anesthesia Safer for a Tummy Tuck?

I am healthy, thin, 31 years old and plan on getting a tummy tuck with muscle repair. I have heard waking up from TIVA is a lot easier and doesn't cause nausea like general anesthesia does. I've also heard it's safer because you continue to breathe for yourself. But most doctors don't offer this option. So which is better and safer?

Doctor Answers 6

TIVA and inhalation anesthesia are BOTH safe . . . but TIVA is better!

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As a fully-trained and American Board of Surgery-certified (now lapsed--no longer practice as a general surgeon since my sub-specialty training in plastic surgery) surgeon, and American Board of Plastic Surgery-certified plastic surgeon in practice for 24 years, I have been on numerous hospital staffs over the 31 years since I graduated from medical school. As an operating surgeon and plastic surgeon for all of those years, I have witnessed many anesthetics being delivered in a hospital setting, in a hospital-owned and operated free-standing surgical center, and for the last 24 years as well, in my own office-based AAAASF-accredited on-site surgical facility. So, while I will cheerfully admit to having a bias, it is one based on substantial personal experience with ALL forms of general anesthesia, delivered by anesthesiologist, anesthesiologist-supervised CRNA (certified registered nurse anesthetist), and independent CRNA working in our and other surgical facilities as independent contractors.

Our head CRNA at Minneapolis Plastic Surgery, for example, is Mayo Clinic trained and still works there part-time in the cardiac anesthesia section. He has several equally-skilled and experienced CRNAs that staff our office facility; I would trust any of them to put me asleep (and have!) or my family members (also have!). We have had the same anesthesia team (with three different head CRNAs) over the past 20 years, and have evolved a TIVA technique that allows multi-hour anesthetics (a 6-hour lower body lift, for example) with very rapid wake-up (short anesthetic drug half-lives), a 2% overall nausea rate, and a 0.05% (8 in over 16,000 procedures over 20 years) hospital admission rate. We utilize a continuous drip pain medication along with the anesthetic agent, so that pain receptors are continuously occupied, not just bolused when the patient responds to pain stimulus or starts to "wake up" during the surgery! We use NO inhalation anesthetics or nitrous oxide that can dilate the gut, middle ear, or sinuses, giving patients that dizzy or bloated feeling, or get absorbed into the fatty tissues, including the brain, which causes slower wake-up and more PONV than IV anesthetic drugs. Since TIVA drugs have such a short half-life, they wear off quickly, reduce post-operative nausea and vomiting (PONV), allowing shorter recovery room times, and an overall smoother and better experience (as compared to inhalation anesthetics).

Most hospitals use inhalation anesthetics because they are just as safe as intravenous anesthetics (TIVA stands for total intravenous anesthesia), but are much less expensive. They are NOT safer, and in fact, a 7-28% PONV rate that requires overnight admission in an inordinate number of otherwise-outpatient anesthetics simply costs more, exposes the elective patient to sick patients and nasty bacteria, and perhaps allows less activity than does a patient at home who has to get up to use the restroom, get pain medication, or come to the doctor's office. In the hospital, a lot of that is done FOR you, and may just cause a tiny bit higher risk of developing a blood clot that increased activity may prevent. So if the hospitals were smart, or were to look at the total experience rather than each department's own individual budget, the "savings" in the anesthetic drug category would be wildly overbalanced by the increased expense of nausea medications, unplanned overnight stays, and the occasional infection from exposure to a sick patient, or blood clot from being kept in a hospital bed with rails up and button in the patient's hand!

BOTH anesthetic regimens are safe, but TIVA performed by anesthesia providers experienced in its use is truly superior for a number of reasons. After all, hospitals are in the business of filling beds, aren't they? I have a slightly different agenda with my patients--only the best will do, regardless of the cost!

Minneapolis Plastic Surgeon
4.9 out of 5 stars 263 reviews

TIVA is better and just as safe.

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Dear Greengirl32,

TIVA is better than inhalation anesthesia because of lower nausea and vomitting, less GI complaints, and faster recovery from anesthesia after the surgery. Dr. Tholen and I are partners and co-owners of our surgery center. We have performed thousands of procedures here using the TIVA technique and have data to support our claims. I would encourage you to call for a complimentary consultation so that you may see our facility in person. Check out the link below. Good luck and I hope to hear from you soon. Dr. Gervais

Douglas L. Gervais, MD
Minneapolis Plastic Surgeon
4.8 out of 5 stars 178 reviews

Anesthesia for tummy tuck

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The type of anesthesia used for a tummy tuck can vary and is determined by the comfort of the surgeon and the anesthesiologist.  Both intravenous and general anesthesia can be used successfully.  The advantages of IV anesthesia are less drugs, quicker recovery, and far less chance of post-operative nausea and vomiting.  An additional option is the addition of a spinal block or an epidural.  Both can be used effectively for outpatient surgery by qualified anesthesia providers.

Jeffrey E. Kyllo, MD
Seattle Plastic Surgeon
4.7 out of 5 stars 13 reviews

Safer anesthesia for tummy tuck

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All forms of anesthesia can be safe for tummy tuck if well monitored, provide excellent pain control, and also give adequate relaxation for muscle repair when required. We favor general anesthesia with a soft laryngeal mask for most and patients do breath on their own. The nausea which can be associated by inhalation agents in anesthesia can be controlled with medication for those that tend to have nausea as not all do. And narcotics in sedation techniques can also cause nausea. Better comes from sound experience, an accredited facility, and a board certified surgeon practicing within his area of specialty.

Best of luck,


Peter E. Johnson, MD
Chicago Plastic Surgeon
4.0 out of 5 stars 44 reviews

General anesthesia is very safe for health patient

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Mac anesthesia is great for short cases but for full tummy tuck you may better off with general anesthesia. If you have Mac anesthesia your surgeon has to compromise on the extent of dissection and muscle work. If you need only skin removal , then local anesthesia with IV sedation be fine.

Kamran Khoobehi, MD
New Orleans Plastic Surgeon
4.8 out of 5 stars 154 reviews

I'm not sure there is a lot of difference.

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Both ways of doing it are good.  Some anesthetists and anesthesiologist can do TIVA with an endotracheal tube and relaxation, others would prefer a general.  Either way the muscles need to be relaxed to get an adequate muscle tightening. I have done them both ways and they both work.  Doing heavy sedation and local can also be done, but I don't feel as if I get as good a muscle repair in these instances.

Good Luck,

Dr T

Scott Tucker, MD
Winston Salem Plastic Surgeon
5.0 out of 5 stars 32 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.