Note: This section on Anesthesia is graciously contributed by Dr. Alan Andacht, one of the select, well- qualified board- certified anesthesiologists I work with routinely. Dr. Andacht and I have worked together since 1994 and he has accompanied me on several Rotaplast missions overseas. Dr. Andacht is also board certified in critical care medicine and has a great bedside manner that immediately sets patients at ease. Dr. Andacht and his equally skilled, highly experienced associate Dr. Jeffrey Katz work with me at different facilities, and provide most of the anesthesia for my cosmetic surgery patients.
– Paul Angelchik, MD
Introduction to Anesthesia
The Role of the Anesthesiologist
As you plan for your surgery, your anesthesiologist is an important part of your health care team. During the perioperative period, (the time right before, during, and after surgery) the primary role of the anesthesia specialist is to make informed medical judgments to protect and regulate your critical life functions while ensuring your comfort.
The goals of your anesthesiologist are to provide the best medical care possible, to deliver safe and satisfactory pain relief during your surgery, and to return you to an alert, awake, and relatively comfortable state within a few hours.
Types of Anesthesia
There are three main categories of Anesthesia: General, Regional, and Local.
When you are under general anesthesia, you are unconscious and have no awareness of other sensations. Some medications are administered in a vein through your IV line while others are inhaled through a mask or breathing tube after you are asleep. The level of these medications is continually monitored until you awaken and are taken to the recovery room.
Regional anesthesia requires an injection near a cluster of nerves to numb a specific area of the body. The two most common in this group are spinal and epidural anesthesia. Regional anesthesia is used less commonly with plastic surgery procedures.
For local anesthesia, an anesthetic drug like lidocaine or Marcaine is injected into the tissue at, or very close to the surgical site. This may be supplemented with intravenous sedative and pain medication to make you more relaxed and comfortable. If intravenous sedation is given by an anesthesiologist this is called Monitored Anesthesia Care (MAC). For a procedure done on an otherwise healthy patient under strictly local anesthesia, an anesthesiologist may not be required.
Anesthesia for Same-Day Surgery
With short-acting anesthetic medications and sophisticated monitoring devices, many surgical procedures are performed safely on an outpatient basis. Same- day surgery can range from a few minutes to a few hours. Anesthetic techniques used today enable you to continue your recovery at home.
Preparing for Surgery
For most procedures you will be told to fast the night before your operation. It is necessary for your stomach to be empty so the risk of regurgitation of any undigested foods or liquids is minimized. Many anesthetic medications depress the gag reflex, which prevents food from entering our lungs while we are awake. If surgery is late in the day, you might ask your physician when fasting should begin. There will be situations where you will be asked to take medications with a sip of water just before surgery. This practice has been proven to be safe and effective.
Prior to surgery, at your bedside, your anesthesiologist will evaluate your current health and medical history, formulate an anesthetic plan for you, and discuss the anesthesia part of the procedure with you in detail. In order to achieve a safe anesthetic, your physician takes into consideration your medical condition, as well as ANY medications or supplements you have recently been taking (including vitamins, herbals, or recreational drugs). Honesty is the best and safest policy. If you have significant medical issues, Dr. Angelchik will request that the anesthesiologist evaluate your health history well in advance of your procedure to ensure that all appropriate precautions are taken in planning your anesthetic. This may include ordering additional diagnostic tests or optimizing other health conditions prior to an elective cosmetic surgery.
At the Surgery Facility
After you have checked in to the surgical facility, Dr. Angelchik will review the plan for surgery with you and do any necessary marking for your surgery. Then, before you go into the operating room, the anesthesia specialist will likely give you some medications to make you feel more relaxed. When you go into the operating room, you will be given more medication to gently induce anesthesia and various monitors will be attached to monitor your vital signs. During surgery, your anesthesiologist will monitor your vital signs, administer the required medications, and assist with your breathing if you are under general anesthesia. At the conclusion of surgery, the anesthesiologist will reverse the effects of the anesthetic medications, and return you to consciousness once again. Pain medications and medication to prevent nausea will be given at the conclusion of your anesthetic and before you are discharged from the facility if needed.
Recovery and Aftercare
After surgery, you will be taken to the Post Anesthesia Care Unit (PACU), commonly called the recovery room. Here you will be watched closely for any immediate post operative problems, and given medications for pain and perhaps nausea if needed. When you meet the discharge criteria of the surgical center you will be released to go home with a reliable friend or family member. It is very important to arrange for a responsible adult to take you home because your coordination and various reflexes might be impaired for at least 24 hours (i.e., no driving). When you are just about ready to go home, detailed aftercare instructions will be provided by your PACU nurse to you and whoever will be caring for you at home including: recommended diet, activity levels, medications for home use, care of your surgical site, and follow- up appointments. The surgical facility staff will contact you the day after discharge to check on your recovery.
All operations and all anesthetics have some risks, and they depend upon many factors including the type of surgery and medical condition of the patient. With modern anesthesia techniques serious adverse events are rare. There are built-in safety measures that are considered “safe practices” which we follow closely throughout your care.
It is certainly reasonable to ask questions regarding your operation, and anesthetic plan ahead of time. You will be given contact information for your anesthesiologist well in advance of your surgery date at Dr. Angelchik’s office. We all strive to bring you the highest level of care with the best surgical result. I look forward, along with the rest of the operative team, to providing excellent care for you on the day of your surgery.
– Alan Andacht, MD