Local or general anesthetic?

[spooon]

What are the pros and cons? Would you favour one over other in particular circumstances? I think I prefer local but some surgeons only carry out general.

[Dr. Elliot Jacobs]

There  is a happy medium between the two -- it is called twilight sleep anesthesia and it is my preferred method.

Twilight sleep (also called conscious sedation) requires the presence of an anesthesiologist, who administers small amounts of medication by vein.  You will go to sleep but there will be no tube inserted into your windpipe and no machine breathing for you.  Once you are asleep, I administer injections of local anesthetic (similar to a dentist) but you don't feel the injections because you are already asleep.  After that, I can do my work while you sleep gently.

The best part is that you awaken within minutes after the completion of the procedure and there is no nausea, vomiting or hangover.  You are mentally alert within 15 minutes.

This method combines the best aspects of all types of anesthesia and provides the most comfort for my patients.  Other surgeons may have different points of view.

My one caveat:  do not opt for local anesthesia because it is cheaper (you don't pay for the anesthesiologist).  The local anesthesia alone (except in rare cases) will not be sufficient to allow for the surgeon to do his best work -- and the result may be disappointing.

Dr Jacobs

[Litlriki]

I used to use conscious sedation for all of my gynecomastia cases in a setting where I provided the sedation through a nurse with special training. That setting changed in my practice, and after that, I've always had an anesthesiologist present to provide sedation or general anesthetic (GA).  They tend to prefer GA, typically using a device called a Laryngeal Mask Airway (LMA), which protects the airway during the procedure and allows for gas delivery without a traditional intubation. The arousal from this technique is often fairly similar to deep sedation when done efficiently, and it's also very well tolerated by the patients. The cost of the two options is the same, so I allow my patients to decide, but most opt for the GA. 

[Dr. Schuster]

Twilight, or MAC, or light sedation are all the same descriptions for the type of anesthesia that cn be used in addition to local anesthetic for correction of most types of gynecomastia correction. I generally reserve general for the largest of corrections using a mastectomy type of removal as well as for patients who are either too nervous or have medical conditions that make it safer to have a general.

[DrPensler]

This is a recurring topic  it seems every few months. I typically use twilight sedation but I do have a small but significant number of patients who want to have the procedure performed under local sedation. In cases of local anesthesia I also start an iv in case the patient changes their mind. Last month I had two patients the same week who had local only this month none. To be clear its not the surgery that is uncomfortable with local its the application of the local anesthesia. Also different patients have different pain tolerances and varying commitments to the idea of local.

[Dr. Schuster]

The choice of anesthesia should be discussed between the patient and surgeon. 90% of the gynecomastia corections i perform are done under a twilight and local anesthesia. Patients don't feel any pain during or after the surgery. It makes for a very pleasant experience. Sometimes more involved surgery or patients who are exceptionally nervous will do best with a general anesthetic. i suppose the surgery can be done under just local - but why?

[George Pope, M.D.]

I prefer general anesthesia over "twilight" or IV sedation.  I think there is a fine line between adequate IV sedation for the surgery where a patient is breathing on his own and need for breathing support with a laryngeal mask as Dr. Silverman alluded to. And I realize that is anesthesia provider-dependent.   Many anesthesiologists I work with prefer the LMA or laryngeal mask anesthesia method.  It works vey well and patients typically wake up quickly, as the outpatient anesthesia drugs keep getting better.