Dr. Yoho's Book

• Copyright
• With Gratitude
• Author's Introduction
• Disclaimer
• 1 The Psychology of Cosmetic Surgery
• 2 Choosing Your Cosmetic Surgeon
• 3 The New Noninvasive Non-Surgical Cosmetic Therapies
• 4 Liposuction: The Truth about Fat
• 5 Dr. Yoho's Philosophy of Facial Rejuvenation
• 6 Facial Laser Peel
• 7 Eyelid Reconstruction
• 8 Face Lifts
• 9 Chin Implants, Cheek & Jaw Implants, & Nose Surgery
• 10 Breast Implants, Reduction and Repair
• 11 Hair Transplantation
• 12 Vein Therapy
• 13 Anesthetics
• 14 What's The Worst That Could Happen
• 15 What Price Beauty? Cosmetic Surgery Costs
• 16 The Brave New World of Anti-Aging Drugs and Diet
• 17 The Cosmetic Surgery Junkie: Doctor, What Else Do I Need?
• Appendix A: My Perspective: Liposuction and Your Genetics By Judy Brandy-Yoho, R.N.
• Appendix B: Dr. Yoho as Your Surgeon

Contact Dr. Yoho

First Name: *

Last Name: *

Phone Number:

Email Address: *

How can we help you?

Yes, please email me about new developments and special offers.

Yes, I agree to the Terms of Use. *

To complete this form please enter the word in the field below: *

13 - Anesthetics

What Kind of Anesthetic is Recommended for Cosmetic Surgery?

There are three levels of anesthesia, although in practical terms they blend into one another:

• Local "tumescent" (usually lidocaine with epinephrine) possibly with some intramuscular or oral medications. This is often a dermatologist's method.
• "Monitored anesthetic care" or "twilight sleep," combined with local anesthetic. The "PK" technique (see below) used in our office is in this category.
• General anesthesia. No local anesthetic is needed, but physicians currently often combine this with the local anesthetic to reduce blood loss. The local also has some effect on post-operative pain.

Bear in mind that the first option is statistically less risky than the second, and general anesthesia is most risky. Exact risks of general anesthesia are difficult to establish. Suffice it to say that the risks of general anesthesia should never be minimized, that it should not be used casually, and that its use might represent a significantly increased risk of death, particularly with liposuction.

Using local anesthetic techniques certainly is possible, but after years of experience with this, we found that too many patients were having bad memories and pain. It's easier for surgeon and patient to combine this with twilight sleep, which is well tolerated and also very safe. We use "Propofol-Ketamine" (PK) intravenous technique, combined with the tumescent anesthetic. This results in virtually no nausea and rarely any memories after the procedure. In other words, people have the perception that they have been under general anesthesia without most of the side effects and risk. And the patients are so lightly sedated that after the drip is turned off, they wake up in just a few minutes. More information regarding PK can be found in my academic paper, published in the American Journal of Cosmetic Surgery. Extensive information and many academic papers about PK anesthetic can also be found at www.DoctorFriedberg.com. A detailed explanation of the tumescent anesthetic is found in the next section.

It is my belief that most surgeons need a nurse anesthetist or anesthesiologist to safely administer "twilight sleep" anesthesia, and certainly for general anesthesia. In poorly trained hands, the drugs are more dangerous than the surgery. This is supported by a report of Los Angeles area fatalities caused by surgeon-administered anesthesia. However, as an emergency physician with the experience of thousands of cosmetic surgery cases I have anesthetized, I feel confident with the limited drugs we administer, and do not use anesthesia professionals unless the patient requests one. We rarely use any opiates (such as Demerol® or morphine) or Valium-class drugs (Versed® for example) intravenously. These medications, especially in larger doses, make the anesthetic and recovery process more unpredictable and dangerous. Intravenous medications have much higher risk than those that are oral or intra-muscular, and the more drugs that are added together, the higher the risks. The American Society of Anesthesiologists recommends, at the minimum, that an individual trained in basic life support should be in the room to monitor the patient when anesthesia is administered by a non-anesthesiologist surgeon. A higher standard is to have licensed personnel - registered nurses or physician assistants — to perform this duty. The modern machines constantly monitor the patients' blood oxygen, blood pressure, heart rate, and electrocardiogram during the cases. This other person monitors the equipment and patient at the same time, as does the physician. Note also that general anesthesia procedures of any length must be accompanied by "automatic leg squeezer" garments to help prevent blood clots. These "milk" the blood out of the leg veins and back into circulation.

One last issue is time under anesthesia. We believe short procedures are much safer than longer ones. Longer anesthesia times (longer surgeries) lead to more chance of blood loss, higher rate of complications such as blood clots, more surgical trauma, and may even indicate a clumsy or inexperienced surgeon. There's no excuse these days to cater to a patient's request for a prolonged "total makeover." Some evidence has developed that such surgeries are much more hazardous than the sum of the risks of each surgery done on different days.

Don't be fooled by claims that as long as you're in a physician anesthesiologist's hands, you are safe under general anesthesia. The factors above are more important and give you a broader perspective regarding the risks. All that aside, however, we respect our anesthesiologist colleagues and believe that you are generally better off with them than with a nurse anesthetist.

Related Links

• Yours Free: A New Body in One Day
• How to Evaluate "Before and After" Photos
• Recovery Tricks of the Trade with Dr. Yoho
• Cosmetic Surgery Consultation Guide
• The Psychology of Cosmetic Surgery
• What’s the Worst That Can Happen?
• Dr. Yoho as Your Surgeon
• 
•