anesthetic question

[Aron]

I have a consultation with a NHS Surgeon next week, before I discuss anesthetic with him i would like some of your opinions if possible.

How negotiable are surgeons with the use of general or local anesthetic? because I would be much more comfortable knowing I am going to be concious during the op. My gyno isn't severe but it is noticeable, it is what i would describe in the small - medium range but with puffy nipples and I am not over weight, I am healthy BMI and Bodyfat and do go to the gym regularly.

Many thanks

[George Pope, M.D.]

There are different types of anesthesia - local, local with intravenous sedation (twilight sleep) and general anesthesia, where you're completely out.  I base my selection of anesthesia type on the severity of the gynecomastia.  There are very few cases where I will perform surgery under local anesthesia - mainly cases requiring only direct excision of tissue directly behind the nipple/areola.  If liposuction is involved, I prefer general anesthesia.  I know some surgeons will do pretty extensive surgery (both lipo and tissue excision) under "twilight sleep"; it's a personal preference.  Regarding cost, if I use my anesthesiologist at all, the cost for him/her is the same whether it's a general anesthesia or IV sedation with local (twilight).  The patient is paying for the anesthesiologists's service.  Straight local anesthesia would be cheaper in my practice, as no anesthesiologist is involved.

Dr. Pope, MD

[Aron]

Thank you for your response Dr.Pope

[Dr. Elliot Jacobs]

I prefer to do virtually all my operations, no matter how extensive, under "twilight sleep" anesthesia in my office operating room suite.  Most gyne operations require some amount of liposuction, and it is virtually impossible to perform this type of lipo under local anesthesia without excessive pain to the patient.  Twilight sleep provides comfortable anesthesia with a quick awake and no side effects such as nausea -- I think it is the ideal anesthetic.

General anesthesia is reserved for extremely large cases or when the patient's medical status requires it.

The type of anesthesia is something that should not be "negotiated" -- it is a decision made by the surgeon in his best judgment, which always includes what is best for the patient.

Dr Jacobs

[Aron]

Many thanks for your reply Dr.Elliot, I appreciate it.

[Litlriki]

I used to do most of my procedures with local anesthesia and conscious sedation, which I administered through a nurse, and the patients did very well with this.  The twilight sleep that Dr. Jacobs describes is actually even "deeper" than what I was doing, and I was able to do fairly extensive procedures with that approach. 

Since 2000, I no longer have the facility where I oversaw the sedation, and as a result, all of my patients have to pay for the services of an anesthesiologist, and as Dr. Pope mentioned, it doesn't matter what type of anesthesia they get, the cost is the same.  Unlike Dr. Jacobs, who most likely works with the same anesthesiologist on every case, I have different people all of the time, so I actually prefer general anesthesia for the sake of consistency and efficiency. I am happy to do the cases with "twilight sleep" unless they are bodybuilders and they're bigger than me, making a potential challenge if they decide to "help" with the surgery.  In most cases, however, the patients opt to go to sleep.

Rick Silverman

[George Pope, M.D.]

    I am happy to do the cases with "twilight sleep" unless they are bodybuilders and they're bigger than me, making a potential challenge if they decide to "help" with the surgery.  In most cases, however, the patients opt to go to sleep.

Rick Silverman

LOL.  I've had a number of big guys who wake up swinging.  It's pretty crazy sometimes.

Dr. Pope, MD

[Dr. Elliot Jacobs]

I completely agree with Dr. Silverman.  Anesthesia, particularly "twilight sleep" (technically called conscious sedation) is as much an art as is surgery.

I have been fortunate to have been working with the same anesthesiologist for over 20 years.  We are a team in the truest sense.  And with a well practiced team, everything in surgery does go better and faster.

On the few occasions when I prefer the hospital instead of my office surgical suite, I use general anesthesia.

Dr Jacobs