As a surgeon, I perform surgery almost daily and have done so for over twenty years. Most weekdays, I walk into the pre-op area, greet my patient, mark my patient, change into scrubs, and prepare for surgery. I watch my anesthesiologist put my patient to sleep, and I watch my patient wake up after surgery. It is routine.
During their initial consultation, many patients ask me if the surgery can be performed under local anesthesia or with them awake. I ask, “Why do you ask?” “I’m scared of anesthesia,” they say. Usually, I respond, “General anesthesia is very safe in healthy individuals like yourself.”
But when you (or me) are the actual patient, it can be different. Apprehension before surgery is normal for everyone, even surgeons. Here’s more about my recent experience being a patient.
How I Felt Before My Knee Surgery
I recently had surgery for a knee injury. The night before my surgery, I knew what I needed to do. I took out my clothes for the next day – comfortable sweats with tennis shoes. Removed my jewelry so that I would have no valuables. And I changed wallets/purses – I would need my ID, insurance card, and a credit card – nothing else. I showered using Hibiclens which is an antibacterial soap to decrease the risk of infection. And I hydrated with fluids all day so that it would be easier to start my IV in the morning, remembering not to eat or drink anything after midnight.
And then it was time to go to bed. I tried to go to sleep at my usual time but found myself picking a fight with my husband. “Why aren’t you coming to bed?” “Aren’t you worried about my surgery tomorrow?”
I realized I was a little nervous. I thought that I was calm. In reality, the reason that I hate surgery is that I’m scared. I don’t like being out of control. When thinking of surgery on myself, I think of everything that can go wrong – uncontrollable bleeding, problems with medications, and as irrational as it sounds – my biggest fear is not waking up after anesthesia.
“I’m scared of not waking up,” I said to my anesthesiologist the morning of surgery. Fortunately, she understood.
General Anesthesia Facts
General anesthesia means that you are unconscious for the procedure. Like everything in medicine, there are risks and benefits associated with it – typically, general anesthesia is safe for healthy individuals undergoing elective surgeries. While some procedures can be performed using local anesthesia, the vast majority of plastic surgical procedures that I perform are done using general anesthesia. And choosing the best option for you involves a discussion of the unique risks and benefits for you, the patient. Minor side effects of general anesthesia include nausea and vomiting, mild confusion after surgery, and a sore throat from the breathing tube.
Risks of general anesthesia are more significant for those who are obese, have a history of sleep apnea, have a family history of malignant hyperthermia, or have a significant history of heart or lung problems.
There are other types of anesthesia where you are not asleep for the procedure. These types of anesthesia include regional anesthesia – like spinal anesthesia or nerve blocks – and local anesthesia. While you are awake for these types of anesthetics, they can’t be utilized for all types of procedures and may carry higher risks under certain circumstances. Local anesthesia is an excellent option for minor and short procedures – scar revisions, mole removals, earlobe repairs for example. However, for longer procedures, there may be some downsides such as the risks of exceeding the safe limit for local anesthetic dosing. Furthermore, if you require medication to help you relax before and during the procedure, these medications can pose risks since some may decrease your drive to breathe. Under these circumstances, general anesthesia may be the safer option.
Bajaj Plastic Surgery’s Anesthesia Procedure
At Bajaj Plastic Surgery, we perform some, carefully selected procedures using local anesthesia. However, many of the surgical procedures that I perform are performed under general anesthesia. All of the procedures requiring general anesthesia are performed by a physician certified by the American Board of Anesthesiology – an anesthesiologist who is there to monitor and care for you while I perform the surgery.
As for my surgery…I had an uneventful surgery, and an uneventful anesthetic experience – I remember very little after leaving the pre-op area. My husband brought me home after surgery, and while I was a little groggy, I had no nausea or vomiting, or other side effects. Now, I’m trying to be patient with my recovery and follow the doctor’s orders.