Concerned about anesthesia?

I occasionally meet with a patient who has concerns about anesthesia. Sometimes they are concerned about giving up control and being completely asleep without knowing what’s happening. Some of them have heard or read stories about people having bad experiences with anesthesia. I’d like to share with you my outlook on how to choose the right anesthesia for your procedure here in my plastic surgery in Stony Brook, and to review with you the safety features of today’s anesthesia choices.

When deciding what type of anesthesia to employ for cosmetic surgery, I believe it is a mistake to base my decision upon a goal to use the least amount of anesthesia to get the job done. With the current state-of-the-art, modern anesthesia techniques, anesthesia is extremely safe. It is my opinion that it is more important to give you, my patient, the best possible surgical experience in addition to the best surgical result. This necessitates putting you in a “mental and emotional place” that exists without anxiety and no perception of passing time. This requires either sedation or general anesthesia. Sometimes, the line dividing sedation and general is quite vague, so it is almost irrelevant what we call it.

For those concerned about the (albeit rare) mild sore throat that sometimes comes after a surgery, it’s important to know that not all surgeries require that a tube, called an endotracheal tube, be placed down the airway. Often, an LMA (short for laryngeal mask airway) is a better choice. The bottom line for me, as your surgeon, is, “what’s the safest choice for this patient and this procedure?”

For instance, if a patient requires complete muscle relaxation (paralysis) then I can’t just heavily sedate them, because they aren’t able to breathe on their own. The anesthesia machine does that for you. However, if it is OK for the patient to breathe on their own during surgery, then sedation without a breathing tube may be the way to go.

An important consideration when we’re talking about various anesthesia choices is this: one of the nice benefits of sedation and general anesthesia is the amnesia that follows. In other words, you wake from surgery with no recollection of the events you just experienced. It’s like falling asleep for a nap, and when you waken, the procedure is over.

In terms of local anesthesia, I believe that local anesthesia really should be limited to very minor procedures or, in the alternative, procedures done upon very select patients who have absolutely no anxiety and I can obtain an adequate degree of anesthesia in a safe manner.

To your health & beauty,
Dr. Mark Epstein

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