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What are the Different Types of Anesthesia Administered During Surgery?

The purpose of anesthesia is to reduce the discomfort associated with surgery and to keep the patient safe while allowing the surgeon to complete the operation. The types and depth of anesthesia patients can undergo fall on a spectrum. As a facial plastic surgeon, I am not an authority on anesthesiology. However, I work closely with anesthesiologists in the operating room. I have cared for patients who have received each of the below types of anesthesia. The descriptions below are simply basic summaries to better educate patients.

Local Anesthesia

Almost all procedures, regardless of the other anesthesia agents given (see below), involve the use of local anesthesia. The purpose of local anesthesia is to reduce or eliminate the local pain associated with the procedure itself.

There are two families of anesthesia agents with multiple medication within these families. Some are shorter acting (e.g., one to two hours) and others are longer acting (e.g., six to eight hours). Short acting and long-acting agents are often mixed to provide the ideal time frame and depth of anesthesia.

Other medications are also sometimes added to the mixture. Epinephrine is frequently added to the local anesthesia mixture. This medication can reduce the amount of bleeding during surgery by constricting the blood vessels in the area injected. Epinephrine also increases the effectiveness of the local anesthesia and can increase the safe amount of local anesthesia which is allowed to be injected. Sodium bicarbonate, which can reduce the pain associated with the initial injection, is sometimes added to local anesthesia as well.

Local anesthesia can numb an area in two ways. First, the anesthesia can numb the area injected. Second, anesthesia injected around a larger nerve that supplies sensation to an entire region of the body can numb that entire region, despite no actual medication reaching the periphery of the area numbed.

It is important to note that local anesthesia not only affects nerves that control sensation but also nerves that control movement. As a result, local anesthesia can cause temporary weakness in the muscle(s) in the area(s) injected.

Oral Sedation

Some patients prefer and could benefit from oral sedation in addition to local anesthesia. These patients may be undergoing procedures such as hair restoration surgery, upper eyelid surgery (blepharoplasty), lip lift, and/or buccal fat removal. These patients may not require being completely asleep but would prefer something to relax. The typical medication given is a benzodiazepine such as Valium. These patients have their vital signs monitored during the entirety of the procedure.

It is important to note that any patient who receives oral anesthesia such as a benzodiazepine needs a caregiver for 12 – 24 hours after surgery. These patients cannot drive themselves home after surgery because of the oral medication.

Intravenous (IV) Sedation

The term “IV Sedation” simply refers to anesthesia in which the patient is given one or more medications to reduce their level of consciousness to make the surgical procedure comfortable for the patient and to allow the surgeon the ability to operate more comfortably. The term also refers to the fact that the patient is breathing on their own and, therefore, does not require a breathing tube (intubation).

There is a wide range in the depth of sedation patients can undergo. Some patients undergo very light sedation where they are awake and able to speak comfortably. Others undergo sedation where they are sleepier. There are many different medications that can be administered intravenously to achieve this sedation. This sedation is performed by a board-certified and licensed anesthesiologist. The anesthesiologist is the expert in administering this anesthesia as well as monitoring of the patient.

Intubation

Some patients benefit from deeper sedation requiring a breathing tube (intubation). The breathing tube protects the airway and is used with an anesthesia machine, which breathes for the patient.

There are two techniques for administering this type of anesthesia. The first technique uses medications administered only intravenously (IV). The second technique uses anesthesia gases that the patient breathes through the breathing tube in addition to medications administered IV.

The Most Appropriate Technique Depends on the Patient, the Procedure, the Surgeon, and the Anesthesiologist

The anesthesia plan is developed in consultation between the surgeon and the anesthesiologist. It is dependent on multiple factors, including the surgical procedure, the estimated time of anesthesia, and the medical history of the patient.

We at Harmon Facial Plastic Surgery have a Quad A accredited surgery suite at our office where we perform many of our procedures. We utilize the expertise of board-certified, licensed, anesthesia physicians for our procedures requiring IV sedation at Harmon Facial Plastic Surgery.

Trust Your Face to a Facial Plastic Surgeon

It is important to seek a fellowship-trained specialist in plastic surgery of the face and neck when you have concerns about your face or neck.

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