Anesthesia at the Clavin Center for Cosmetic Surgery
Thomas Einstein M.D.
Director of Anesthesia
ANESTHESIA AT THE CENTER
At our center, doctors who are board certified anesthesiologists work with your surgeon to keep you safe and comfortable through surgery and recovery. The anesthesiologist will see each patient before surgery, evaluating their medical history, and developing an individual anesthetic plan.
All patients are closely monitored throughout their watched by the anesthesiologist with the aid of electronic monitors of heart, lung and circulatory functions. Using a combination of the intravenous medication, propofol, and local anesthesia in the surgical areas, our patients are kept unaware, and remain comfortable during surgery. They breathe on their own, and awaken within minutes after surgery is done.
We prefer to use anti-inflammatory medications rather than narcotics together with the local anesthesia to prevent pain, and decrease side effects, we also avoid the use of powerful anesthetic gases which can cause severe post-operative nausea. Although many of our patients complain about feeling sick after previous surgeries in other facilities, it is very rare after surgery at our center.
Q: Who gives the anesthesia in your center?
A: At the Clavin center anesthesia is given by Medical Doctors who are board certified by the American Board of Anesthesiology. These doctors have completed at least three to five years of an accredited training program after graduating from medical school. In addition, they have passed both written and oral examinations administered by the American Board of Anesthesiology. The anesthesiologists at the Clavin Center have extensive experience with patients of all ages and medical conditions both inside and outside of the hospital.
Q: I am very sensitive to medications. I have trouble coming to after surgery. How will you wake me up after my procedure?
A: The dose of the anesthetic, propofol is individualized for every patient and every surgery throughout the procedure. Propofol acts rapidly when given through the IV, and wears off very quickly when it is stopped. Propofol is given to the patient using an electronic pump programmed with the patient's weight. Observing the effect of the medication, the anesthesiologist uses the pump to instantly increase or decrease the dosage as needed. Since the surgery area is numbed up with local anesthesia, the patient will wake up right after surgery with little or no pain.
Q: I get nauseated after surgery. How will you prevent this?
A: Nausea is extremely rare at our center even if you've had problems before. We avoid those medicines that cause problems. Certain medications frequently cause nausea in sensitive patients, especially narcotics like morphine, demerol, vicodin, darvon and codeine. Anesthetic gases which are used by most anesthesiologists in most cases also cause nausea and vomiting. There are excellent new anti-nausea medicines including zofran and anzemet which can decrease problems. Some patients have a strong history of motion sickness, and are much more likely to have nausea after surgery. The transderm scop patch is an excellent choice in these cases. However, we feel the best way to prevent nausea is not to use nausea provoking medicines in the first place.
Q: Do you use twilight sleep?
A: “Twilight” sleep or anesthesia is a non medical term used to indicate a condition between totally asleep and awake. Unfortunately, this technique has often been used by personnel not trained in anesthesia. They often use a hodgepodge of different drugs, and are in poor control of the patient's anesthesia. Under twilight, Patients often experience pain during surgery, and wake up slowly after surgery. Patients commonly wake up in pain and frequently suffer from nausea.
In contrast, at the Clavin Center, Medical Doctors trained in anesthesia use medication in a precise manner to control the patient experience. The patients are asleep and comfortable through their operations. They wake up immediately after surgery and are comfortable and usually ready for discharge in 30 to 45 minutes. Nausea is extremely rare. In the unusual case where a patient wishes to be awake during surgery, the anesthesiologist and the surgeon can use a combination of local and regional anesthesia, and short periods of sedation as needed to minimize any discomfort.
Q: What are the risks of anesthesia?
A: Modern Anesthesia is extremely safe. The risks are is lowest in those with no medical problems. The risks remain low if medical conditions are mild and/or well controlled. In ambulatory surgery centers with patients whose medical problems are generally well taken care of, the incidence of death due to anesthesia has recently been quoted as one in 200,000 patients. To minimize your risk of problems, your surgeon and anesthesiologist will evaluate you, and work with your personal physician to make sure you are in the best possible condition before surgery. Your anesthesiologist will monitor you closely during surgery to treat you for any unexpected problem. At the Clavin center, the surgeons and anesthesiologists are certified providers of advanced cardiac life support, and we maintain a full set of emergency medications and devices. Although it has never been necessary, we can transfer patients to Saint John's Medical Center, immediately next door to our medical building.
Q: Will I be asleep?
A: Patients are often concerned about awareness while having surgery. Although this is a very rare event, it has received a lot of media coverage recently. The worst horror story is: “I felt everything, but I couldn't move or speak.” These unfortunate patients, received paralyzing medications (also called muscle relaxants), without adequate sedative, or sleep medications. This should never occur when anesthesia is properly administered and monitored. While many plastic surgery centers use paralyzing agents routinely, at the Clavin center we almost never use them.
Q: Will I have a sore throat?
A: Patients often suffer some sore throat after surgery, because many anesthesiologists routinely place breathing tubes in the nose or the mouth during surgery. You are very unlikely to have any throat discomfort after surgery at the Clavin Center, because we rarely use breathing tubes.
Q: What if I have a complication?
A: Most problems can be immediately handled at the center by the anesthesiologists and surgeons. If other physicians are needed, the staff doctors are all affiliated with the local. hospitals and can call on their medical colleagues as needed. Although it has never been necessary in the past, in an extreme case a patient can be transferred to Saint John's Medical Center, immediately next door to our medical building.
Q: Will you use needles? I hate needles.
A: No one likes needles! We do need to place an IV (intravenous catheter) on all surgery patients. This is a very slender plastic tube that is threaded over an even narrower needle into a vein in the arm, forearm, or hand. We usually pick the least painful site for the IV which is typically at the elbow crease. We routinely use buffered (less painful) local anesthetic placed with the smallest needle available to numb the IV site before we place the IV, and we generally place small IV catheters. If even this is considered too painful by the patient, we will be happy to prescribe a topical anesthetic cream that can be placed one to two hours before surgery. We will work individually with patients who are extremely phobic and work out a strategy including oral sedatives before their procedures.
Q: Will you put a mask on my face?
A: In any facial procedure, it is extremely unlikely that a mask will be used. For other procedures, we often use a mask for giving supplemental oxygen, and nitrous oxide (laughing gas) for additional sedation. In any case the mask is only placed on the face when you are asleep.
Q: Is it dangerous to be under anesthesia for a long time?
A: With the appropriate treatment and monitoring there should be little or no increased risk in a longer surgery. The biggest risk in long surgeries is blood clot formation in the legs. These clots can travel to the lungs and cause severe breathing and circulation problems. This is rare, but happens more often when the legs are immobile for long periods of time as during surgery or on a long trip. To decrease this risk, we routinely place sequential compression (SCD) stockings. These stockings squeeze the leg muscles every few minutes to mimic the normal pumping action of the legs, and prevent clot formation.
Q: What are the different kinds of anesthesia?
A: There are several broad categories of anesthesia. These include local anesthesia, regional anesthesia, general anesthesia and monitored anesthesia care. A wide variety of techniques and medications can be used to accomplish each of these types of anesthesia.
To give local anesthesia, we inject anesthetic medication directly into an area to rapidly numb it up before surgery.
For regional anesthesia, we inject small amounts of local anesthetics in strategic points to numb up wide areas. Examples of regional anesthesia include spinal and epidural anesthesia, as well as forehead blocks and intercostal (between the ribs) blocks.
General anesthesia is done by giving enough medication to stop pain pathways in the brain, so that patients will no longer react to what would normally be painful stimuli. The anesthetics are given either IV (intravenously) as a liquid, or by inhalation as a gas, or by a combination of gas and IV.
Monitored Anesthesia Care or MAC refers to a combination of anesthetic techniques. Typically local and/or regional anesthesia is given by the surgeon and/or anesthesiologist. In addition medication is usually given intravenously, to maintain a comfortable state throughout surgery. Patients can be kept asleep or awake as desired.
In all types of anesthesia, the anesthesiologist observes the patient directly, and also uses sophisticated electronic monitors to continually assess the patient's comfort, and assure the patient's safety.
Q: Why can't I eat before surgery?
A: Patients are asked to fast before surgery to minimize the risk of aspiration pneumonia (lung infection). Normally, we will not inhale food particles into the lungs, because we have a gagging or protective reflex. This protective reflex can be decreased under anesthesia. If food comes up from the stomach, it can enter the lungs and cause severe breathing problems. Although serious, this is a rare complication that can be further minimized by fasting before surgery. Patients who have stomach or esophagus problems involving acid or reflux may be at increased risk for aspiration. It is a good idea to notify your surgeon and anesthesiologist, since appropriate preoperative medication in addition to fasting can be very helpful.
Q: I am on medication. Should I take my medicines before surgery?
A: Generally we prefer patients to continue their routine medications before surgery. There are some medications that should not be taken before surgery. We will discuss these with each patient when they schedule for a procedure
Q: What is the difference between inpatient and outpatient anesthesia?
A: Outpatient anesthesia is designed to get patients awake and comfortable as soon as possible after surgery. The medications that are used for sedation will wear off quickly. Longer acting local anesthetics and other medications are used, so that our patients are comfortable when they wake up. They will be easily taken care of at home, or at an after care facility.
Q: How will I be able to leave the Clavin Center so soon after surgery?
A: The medicines we use are fast acting, and wear off quickly. We use long acting local anesthetics, and other medications to wake you up in comfort.
Q: Does the anesthesiologist stay with me during surgery?
A: Surgical anesthesia is a one on one experience. At the Clavin Center, your anesthesiologist monitors you from the IV start until the time you wake up.
Q: I'm from out of town, how long do I have to stay in the area after surgery?
A: Less than you think. Every case is individual and can be decided between the surgeon and the patient. In some cases two days are enough. In others, it may be better to stay a few extra days for suture removal and follow-up care.
Q: Where do I go after surgery?
A: For some procedures, you can go home with a responsible adult. We give patients specific written instructions with 24 hour follow-up telephone numbers for any questions or problems. For other procedures or if the patient prefers, we recommend an aftercare facility. We work with several different facilities in the area, and will be happy to recommend the one which bests fits your needs.
Q: I have additional questions about anesthesia at the Clavin Center. How can I get answers?
A: You can email Dr. Einstein at einstein@jovanet.com for any other anesthesia related questions.
