general anaesthesia vs IV sedation?

[Needsomeadvice]

Did you have your surgery done with general anaesthesia or IV sedation+local ?

If you had to do it over, which one would you pick ?

Did you experience any pain during the procedure or were you asleep?

[dondante]

I was nervous about the GA, but so glad I had it that way. You fall asleep and in what feels like a moment later, you wake up and it's all done. GA all the way!

[iFlow]

General is the way to go, but I'm so creeped out. Like you hear all these stories about people not waking up...AHHH! lol

[Dr. Elliot Jacobs]

Many surgeons prefer general anesthesia -- and it is perfectly fine.

I perform the majority of my gyne surgery in my office operating room (accredited by the Joint Commission) on an out-patient, ambulatory basis -- rather than in a hospital. This works best for my patients -- no impersonal hospital personnel, no additional and unexpected hospital fees, etc, etc.  In order to accomplish this, we need anesthesia which  allows for a quick recovery.  For the vast majority of cases, IV (Intra-Venous sedation) is ideal.  However, just like surgery, it is an "art" form.  Some surgeons administer the medications themselves; others (myself included) have a separate anesthesia doctor.  In its best form, IV sedation (sometimes called "twilight sleep" or "conscious sedation") provides a smooth gentle sleep in which the patient feels absolutely nothing and is totally unaware of the passage of time.  It's as if you drift off to sleep and awaken 2 minutes later -- and the operation has been completed!  Once the patient is asleep, I will administer injections of local anesthetic -- but these injections are not felt by the patient.  To contrast, general anesthesia requires a tube to be placed in your windpipe and a machine to breathe for you.  You have to be more deeply anesthestized so as not to fight the tube -- thus more drugs and a slower wake-up and recovery.

I am proud to have worked with my anesthesiologist for over 15 years.  We work as a team -- effortlessly and smoothly.  His induction of IV anesthesia is gentle and the patient is carried through the surgery at a nice level -- not too "deep" and not too "light." He is totally unaware of the passage of time and obviously there is no pain at all! And then, when the last stitch is going in, the patient awakens gently, with no nausea, hangover or grogginess.  He opens his eyes and talks to us. And within 15 minutes, he can be moved to the recovery room.  Believe me, there is a true art to assessing each patient's needs and providing just the right amount of medication to keep him at the right level.  Together, we have used this technique on men from 135 pounds to over 400 pounds!

I, for one, believe that a good anesthesiologist providing IV sedation is the ideal method for gyne surgery.

Dr Jacobs

[DrBermant]

Did you have your surgery done with general anaesthesia or IV sedation+local ?

If you had to do it over, which one would you pick ?

Did you experience any pain during the procedure or were you asleep?

Plastic Surgery Anesthesia has evolved over the years.  It is an art form that can result in an amazing degree of patient comfort.  Although I prescribe a strong pain medication for my patients after surgery, most tell me that plain Tylenol alone is more than enough the control their comfort.  Once the tumescent anesthesia wears off, they feel like they have had a major work out and feel sore.  The guiding principle has been preemptive pain management. Check out the specific doctor's patient experiences to best learn what they are offering.

General Anesthesia can be a valuable tool for some operations.  Patient comfort involves medications given by IV and inhaled through the lungs.  This involves a tube inserted through your mouth which can make the throat sore.  The deepness of general anesthesia requires additional medications that your body must metabolize to wake up.  Unless local anesthesia is used in addition, patients waking from general alone tend to be in great pain as their general medications wear off.  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.  Patient comfort is still dependent on the local anesthesia and the amount of General needed is much less.   This is much more extensive surgery for the massive weight loss patient and is hospital based for recovery issues.  You can learn about Body Lift Surgery Patient Experiences here.

Local with Sedation is not as deep.  Comfort is dependent on the tumescent medication administered to the site and possibly some given through the IV.  This is what I prefer for almost all of my gynecomastia surgery.

Local Anesthesia Alone just depends on the medication given to the site itself.  I prefer local anesthesia alone for long nipple reduction gynecomastia.  This is not enough for a major gynecomastia contouring operation.

For almost all of my gynecomastia surgery, local anesthesia with sedation provides a safer much more comfortable method.  The patient starts with medication from an IV given by my Anesthetist.  He is an artist who blends various medications that gently drift each patients off to sleep.  We have been working as a team for many years.  By the end of the operation the patient awakes, comfortable, with no nausea, and unaware of the time that has transpired.  My local anesthesia and tumescence is given after the patient is asleep.  The vast majority of my surgery is done at my Accredited Surgery Center.

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. 

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.

Patient Experiences
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:

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

[PSC0002]

From a patient prospective I wasn't bothered by GA.  I'm sure every PS has his way of doing things though. 

I went to sleep with boobs and woke up without.  Wasn't a big deal, minus the vomiting i experienced afterwards.  Don't know if I'll blame that on the GA though, more likely too much pain meds and not enough phengran.  I'm a pain med light weight.  It's too bad too, I wish I could have enjoyed the Fentanyl more

[Dr. Elliot Jacobs]

As previously stated, both general anesthesia and IV sedation are suitable -- it depends on the patient as well as the surgeon's comfort level.  One positive for IV sedation is that less total drugs are used so that the incidence of post-operative nausea and vomiting is considerably less.  Also, in my practice, we use Zofran immediately PRE-OP.  Zofran is a powerful anti-nausea drug.

Dr Jacobs