Local with IV Sedation

[smithers]

I have my surgery next week and I am beginning to get nervous. I decided to have the surgery with local anesthesia and IV sedation instead of the general. My question is simply this, with IV sedation do you remain awake and for those of you who have had the surgery under IV sedation did you remember anything post opp?

[mrpower33]

No, you're not awake.  You are knocked out and you won't remember anything, you probably won't even remember the last few minutes of being conscious before the operation.  Basically they were talking to me and the next thing I knew it was over. 

[Dr. Elliot Jacobs]

Coffee is not totally correct.

Intravenous (IV) sedation, when properly administered by an anesthesiologist, will allow you to drift off to sleep.  You will NOT be awake, you will NOT hear anything, you will NOT feel anything, and you will NOT be aware of the passage of time.  In essence, it is a deep sleep but you are NOT unconscious.  When the last stitch goes in, you will awaken -- refreshed, rested, in no pain and with no nausea or hangover.  I believe it is the ideal anesthesia for this type of surgery.

This process is performed by a master anesthesiologist who will monitor your vital signs and, with the judicious administration of tiny doses of several medications, keep you at just the right level -- yet ready to wake up easily when the operation is completed.

General anesthesia, which certainly is an acceptable alternative, involves the use of deeper anesthetics and the placement of a tube in your windpipe (trachea) and a machine (respirator) which will breath for you during surgery.  Since it is a deeper anesthesia, the wake-up is slower and you may be groggy for 12-24 hrs.  There can also be some nausea or queasiness -- and a sore throat for a while.

With either technique, you will not feel anything.  And from a patient's perspective, it will seem as if you had just gone to sleep and awakened immediately two minutes later, even though 1-2 hours may have passed.

Wide awake with local anesthesia, which requires several injections of anesthetic medication into the chest (and these can be uncomfortable), really works only for a very localized gyne just under the areola.  If there is additional tissue extending beyond the areola or if there is indication for liposuction to "feather" the edges or to remove fat (both very common situations), local anesthesia is totally inadequate.  I learned this lesson many years ago when I tried to do just this -- there are still claw marks on the ceiling of my operating room to prove this is not the way to go!

Trust this answers some of the questions.  If anyone has more specific questions, send me a PM.

Dr Jacobs

[DrBermant]

I have my surgery next week and I am beginning to get nervous. I decided to have the surgery with local anesthesia and IV sedation instead of the general. My question is simply this, with IV sedation do you remain awake and for those of you who have had the surgery under IV sedation did you remember anything post opp?

Plastic Surgery Anesthesia has evolved over the years.  Sedation is an art form and when done well, patients drift off to a comfortable sleep awakening gently at the end of surgery.

I prefer local anesthesia alone for long nipple reduction gynecomastia. For almost all other gynecomastia surgery, local anesthesia with sedation provides a safer much more comfortable method.  When 2 stages are needed, as with this problem of enlarged nipples of gland and nipple tissue, I perform the first stage with local sedation, and the second with local alone.  For my upper body lift surgery, when I have to operate all around the chest - front / back, I need Light General Anesthesia.  This is still my Tumescent Technique, but adds the safety of airway protection while the patient is in the prone position.

I perform many revision gynecomastia surgery on patients first done elsewhere.  Many have told me how unpleasant their first doctor's experiences were under local anesthesia alone or General Anesthesia for liposuction and gynecomastia surgery.

You can find an extensive individual patients' experience with comfort and my Tumescent Technique Anesthesia for gynecomastia here.

If you prefer direct links to each of those discussions about Anesthesia Experiences with Sedation:

anesthesia and comfort in gynecomastia patient from California

anesthesia and comfort after revision gynecomastia surgery in patient from Hong Kong China

comfort and anesthesia in physician's son with gynecomastia

comfort and anesthesia in gynecomastia patient from Florida

comfort and anesthesia in gynecomastia patient from Illinois

comfort and anesthesia with gynecomastia patient from Texas

comfort after gynecomastia surgery with patient from Colorado

comparing comfort and anesthesia of my revision surgery with prior gynecomastia surgery in Florida

comfort and anesthesia in patient 4 hours from Richmond with gynecomastia

parent of teenage gynecomastia patient commenting about comfort after surgery

comfort after gynecomastia revision surgery on patient from the United Kingdom

comparing comfort of my revision surgery to prior gynecomastia surgery done in New York

Hope this helps,

Michael Bermant, MD
Learn More About Gynecomastia Surgery

[Dr. Elliot Jacobs]

BTW, I forgot to mention that during IV sedation, local anesthetic is injected (but you do not feel the injections because you are sleeping gently).  And there is absolutely no memory of the operation when you awaken.

Again, I feel that IV sedation anesthesia, supplemented by local anesthetic injections, is the ideal type of anesthesia for the majority of routine gynecomastia operations.

Dr Jacobs

[smithers]

Thanks you everyone for your responses this makes me feel a little more at ease. Coffee, I don't know about being strong I just had enough of the gyne.

[mizuno]

Dr. Jacobs,
What is the percentage that you use w/ local IV sedation anesthesia ?
I agree w/ all that this is the best way to go.

[Dr. Elliot Jacobs]

Roughly 90 - 95% of my gyne surgery is performed under IV sedation with local anesthesia supplementation in my office operating room suite on an ambulatory basis.  The balance of my operations are done either under local anesthesia alone or under general anesthesia at a hospital.

Dr Jacobs

[Merangue]

there are still claw marks on the ceiling of my operating room to prove this is not the way to go!

 
Wow, that sounds scary.