Should I use IV sedation or General Anesthesia for my cosmetic surgery procedure?
General Anesthesia is different from IV sedation and the differences have a major impact in the recovery from surgery, as well as the risk level of surgery. I will explain some of the differences between the two and why you should think about it seriously before making your choice of anesthesia. The principal difference is that under General Anesthesia the anesthesia provider controls your breathing with an endotracheal tube (inside your windpipe) , whereas under IV sedation you are breathing on your own. Each type of anesthesia has its uses, and a lot depends on how the anesthesia provider and surgeon work together.
Often referred to as “I.V. Sedation, or Conscious Sedation,” twilight anesthesia allows patients to be sedated without completely losing consciousness. Patients under Conscious Sedation are carefully maintained in a state of drowsy relaxation during their surgical procedure. It is common for patients to fall into a light sleep during this type of anesthesia. The medication for sedation is delivered intravenously, while the surgeon or anesthesiologist injects the area to be operated on with a local anesthetic (ie, numbing medicine) for pain.
It is completely normal for people to remember being in the operating room while under Conscious Sedation, or to remember people talking to them while the procedure is occurring. It is also possible to have vivid dreams, and to recall them after the procedure. These are all normal with Conscious Sedation, yet many people remember nothing at all. You should not feel pain, however, during this anesthetic, because the area to be operated on will always be numbed by the surgeon. These numbing medications last anywhere from 1-6 hours.
As with any anesthetic, all of the patient’s vital signs are continuously monitored throughout the procedure, but a breathing tube is not required Conscious Sedation because the patient is responsive enough to continue breathing. The recovery period for Conscious Sedation is usually very brief, and many patients feel better after this type of sedation than with general anesthesia.
IV anesthesia allows a patient to have a surgery where she is awake enough to be breathing on her own, will not experience pain, and will not remember the event. With IV anesthesia there is no risk of malignant hyperthermia or blot clot to the legs or lungs, as those risks are only associated with general anesthesia. Thus, properly monitored IV anesthesia is a safer choice than general anesthesia
Normally delivered through a combination of inhaled gasses and intravenous medications, general anesthesia causes patients to lose consciousness, and remain unable to feel any pain during the surgical procedure. Patients under general anesthesia do not respond to pain signals or surgical manipulations, and should not have any memories of their surgical procedures.
When general anesthesia is used, patients are continuously monitored, and the vital signs are kept within normal ranges. Anesthesiologists will track heart rate and rhythm, blood oxygen levels, temperature, and other critical vital functions. They may also monitor the patient’s depth of anesthesia, to ensure that the appropriate level of anesthetic agent is maintained. Because the muscles that control breathing and movement often are relaxed under general anesthesia, a breathing tube (endotracheal tube) is often inserted once the patient is unconscious. Once the endotracheal tube is in place, the patient is connected to an anesthesia ventilator where breathing functions carefully controlled.
Recovery from general anesthesia is generally longer than after twilight anesthesia. The time of the recovery depends on many factors, but usually patients spend between 1 and 3 hours in the Post Anesthesia Care Unit (PACU). Common side effects include shivering, nausea and vomiting, sore throat, and drowsiness. These should be discussed with your anesthesiologist.
Before any surgical procedure, patients will undergo a history and physical examination by their anesthesiologist (usually done just prior to the operation). This provides the opportunity for the patient and their family to ask any questions related to their anesthetic; and to discuss any anesthetic problems in the past.
Which type of anesthesia is safer?
If the procedure is less than 4 hours, it really depends on which technique the anesthesia provider and surgeon are most comfortable with. Most anesthesia providers feel more comfortable with General Anesthesia because they have total control of the airway. An anesthesia provider experienced with IV sedation can routinely keep the airway secure, but it takes constant attention. IV sedation is technically harder. You need a surgeon proficient with local anesthetic techniques.
Cases longer than 4 hours are a different story. The risk of complications of General Anesthesia increase proportionately with time. After 4 hours the risk of anesthesia itself becomes a factor independent of the surgeon. Complications to the lungs and blood clots increase to a point both the surgeon and patient must weigh risks and benefits carefully. In contrast, the record of safety for IV sedation in long cases is well documented. Once the tumescent anesthesia has set, the patient can be at a more superficial level of sedation for the duration of the case.
What is the difference in recovery Twilight Anesthesia vs. General Anesthesia ?
IV sedation has less side effects such as nausea, less risk of blood clots and lung complications, and patients recover much quicker.
After a long period of IV sedation , patients are able to come out of anesthesia rapidly. With General Anesthesia, patients emerge slowly from General anesthesia after a long period of anesthesia. This has implications. patients stay in the recovery room for 1-2 hours before their vital signs are stable enough, and often have to be admitted overnight because of nausea.
Summary of Twilight Anesthesia vs. General Anesthesia
Above all, both surgeon and anesthesia provider should feel comfortable with the anesthesia plan. If the surgery is going to be long, you, as a patient, should weigh carefully the risks and benefits of prolonged general anesthesia. If you choose IV sedation, it is crucial both surgeon and anesthesia providers are very familiar with the technique.
Our surgeons agree given experience with both General Anesthesia at a state-of-the-art hospital and IV sedation in an out-patient surgical clinic environment, They have drawn several conclusions. IV sedation has less side effects such as nausea, less risk of blood clots and lung complications, and patients recover much quicker.