A ^Retired Plastic Surgeon's Notebook

Anesthesia Smackdown!

Seattle Plastic Surgeon blogs about the MYTH of local anesthesia being safer than general anesthesia.

Lisa Sowder blogs about the types of anesthesia

General Anesthesia vs Local Anesthesia. The winner is???????????????

I would  like to dispel the myth that local anesthesia is somehow safer than general anesthesia.  There are some practices that use the “we only use local anesthesia” as a selling point to imply that their practice is  safer, more advanced or “less invasive”  than a practice that offers general anesthesia.  My advice is to really look into the anesthetic options and  not go with a physician who offers only local  anesthesia.

A physician who does only local may do only local because he/she is flying under the radar of state regulations for office surgery.  Office operating rooms that do not provide general anesthesia are often exempt from certification and/or inspection at the state or federal level.  Another reason for a physician  to do only local is lack of proper anesthesia equipment which (like everything else in the medical industrial complex) is expensive.  And yet another reason is that the only local physician cannot find and an anesthesiologist to work with him/her for various reasons or the only local physician does not have privileges to do the procedure in a hospital that can provide general anesthesia.   If you aren’t saying YIKES, you may want to go back and read this paragraph again.  Also, read this related blog.

Local anesthesia works great for many procedures.  I do some minor face, breast, body and lipo cases with only local.    In these cases, I can keep the cost down, the patient comfortable, the recovery rapid and, unless I have used sedation, the patient can often drive him or herself home.  Sweet, huh?

But for many major or lengthy procedures, it is downright dangerous to use only local because the dose needed to provide comfort for the patient may exceed the toxic level.   All local anesthetics need to be administered within a safe dose and that safe dose varies with the area being injected, how fast it is injected, whether or not the local contains epinephrine and the size and health of the patient.    And the really scary part is that a local anesthetic overdose is often not evident until hours after the surgery has ended, when the patient is not longer in a doctors office, surgery center or hospital.  Patients can die from local anesthetic overdose.  This tragedy happened a couple of years ago in Bellevue, Washington at a clinic that only does local.  It this particular case, the patient kept complaining of discomfort during her extensive liposuction procedure and the doctor kept injecting local, way beyond the recommended dose.  He did not have an anesthesiologist there to help him keep the patient comfortable with intravenous sedation or general anesthesia or to help him keep track of how much local he was using.   She did not suffer the consequences of the overdose until hours after she left the office

There is no cosmetic surgery result so fabulous (or a price for that fabulous result so low) that  is worth dying for.  For my major cases, I really, really want to have an anesthesiologist there either to provide the general anesthesia or, in cases where I am injecting the local anesthesia, to provide sedation and monitoring and airway control (another topic and another blog) if needed.

Yes, the anesthetic equipment and anesthesiologists are expensive, and inspection by state and federal agencies are a hassle.   But the expense and hassle are well worth the safety that all patients, including cosmetic surgery patients, deserve.

Remember, better paranoid than sorry.  Thanks for reading.    Dr. Lisa Lynn Sowder.


Category: Patient Beware, Patient Safety, Plastic Surgery | Tags: , , , , ,

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