How much more dangerous is General anaesthesia vs local anaesthesia w/sedation

[Steve Dell]

Almost every doctor I am looking at seem to want to use general anesthesia instead of local anesthesia with sedation.   

I am not sure if I should insist of the local with sedation or maybe choose another doctor over this issue.

My question is how much does your risk go up using general anesthesia vs local with sedation?

If both methods know you out so you can't feel pain, why not always choose the safer of the 2 methods? Especially in a case of mild gyno.

Is general anesthesia just a deeper form of sedation or is the concept totally different?

Thanks

[morpheus11]

This is also one of my biggest concerns.  If you search bar on the site, you might be able to find some more info.  If not, I suggest you go to Dr. Bermat's website.

I'll be following this post since it's something I'm interested in hearing as well.

[DrBermant]

Almost every doctor I am looking at seem to want to use general anesthesia instead of local anesthesia with sedation.   

I am not sure if I should insist of the local with sedation or maybe choose another doctor over this issue.

My question is how much does your risk go up using general anesthesia vs local with sedation?

If both methods know you out so you can't feel pain, why not always choose the safer of the 2 methods? Especially in a case of mild gyno.

Is general anesthesia just a deeper form of sedation or is the concept totally different?

Thanks

Anesthesia is an art form, understanding a particular surgical team's patient experiences can be as critical as looking at the results of the surgery. If a doctors type of anesthesia is as good or better is best determined by finding actual patient experiences with that method. I addressed the same question here:

https://www.gynecomastia.org/smf/index.php?topic=21551.msg146014;topicseen#msg146014

I do not like general anesthesia for this surgery. There is just too much added risk for nausea and vomiting even in the most experienced hands. In addition, I like knowing I am keeping my patients comfortable through out the operation and the local with heavy sedation accomplishes that quite nicely.

Hope this helps,

Michael Bermant, M.D.
Board Certified
American Board of Plastic Surgery
Member: American Society of Plastic Surgeons and American Society of Aesthetic Plastic Surgeons
Specializing in Gynecomastia and Surgical Sculpture of the Male Chest
(804) 748-7737

[Dr. Elliot Jacobs]

There are basically three types of anesthesia:

1. local anesthesia alone -- which means an injection to numb the area
2. local anesthesia plus deep sedation (usually administered by a separate anesthesiologist but sometimes administered by the surgeon)
3. general anesthesia  -- always administered by an anesthesiologist (ie an MD) or nurse anesthetist

Each type of anesthesia is useful for certain circumstances.  Also, every surgeon has his own preferences.  And every patient situation is different as well.  For example, there may be a case where local anesthesia only is indicated (usually just very small gyne or puffy nipples) -- but the patient is simply scared stiff.  Then sedation or even general anesthesia may be advised.

All anesthestic procedures are quite safe.  My personal preference is local anesthesia plus sedation.  This provides ideal patient comfort plus a quick recovery with no nausea, vomiting, hangover, grogginess or sore throat (from the tube used during general anesthesia).  The patient is sleeping, feels no pain, is not aware of anything and yet awakens within minutes after the procedure is completed.  Most patients will state that they felt it was only a minute or two that had passed since the beginning of their operation.  One big caveat here:  the surgeon must be skilled in administering local anesthesia as well.  If it is not injected properly, then no amount of sedation will suffice and then general anesthesia would be better.

Dr Jacobs

[Steve Dell]

There are basically three types of anesthesia:

1. local anesthesia alone -- which means an injection to numb the area
2. local anesthesia plus deep sedation (usually administered by a separate anesthesiologist but sometimes administered by the surgeon)
3. general anesthesia  -- always administered by an anesthesiologist (ie an MD) or nurse anesthetist

Each type of anesthesia is useful for certain circumstances.  Also, every surgeon has his own preferences.  And every patient situation is different as well.  For example, there may be a case where local anesthesia only is indicated (usually just very small gyne or puffy nipples) -- but the patient is simply scared stiff.  Then sedation or even general anesthesia may be advised.

All anesthestic procedures are quite safe.  My personal preference is local anesthesia plus sedation.  This provides ideal patient comfort plus a quick recovery with no nausea, vomiting, hangover, grogginess or sore throat (from the tube used during general anesthesia).  The patient is sleeping, feels no pain, is not aware of anything and yet awakens within minutes after the procedure is completed.  Most patients will state that they felt it was only a minute or two that had passed since the beginning of their operation.  One big caveat here:  the surgeon must be skilled in administering local anesthesia as well.  If it is not injected properly, then no amount of sedation will suffice and then general anesthesia would be better.

Dr Jacobs

Can a patient request that an  anesthesiologist do heavy sedation with local or do doctors generally have their preferred method which it hard to deviate from?

His website states " Also, during a cosmetic procedure under general anesthesia the operated area is infiltrated with a local anesthetic so the procedure now becomes essentially painless; therefore the anesthesiologist needs to use much less general anesthetic than for i.e., intra-abdominal or orthopedic surgery"   

So apparently he is saying that he won't use that much general anesthetic so its safer. I don't know. 

What do you think?

Thanks

[Dr. Elliot Jacobs]

Honestly, very few doctors will deviate from their standard procedures to accommodate a patient's request.  After all, the standard methods used by each surgeon are what he is comfortable in doing.  Furthermore, what is important is the results of the surgery -- you would not want to compromise that by asking a surgeon to be less comfortable in doing the procedure.

Yes, even under general anesthesia, most surgeons will inject local anesthetics as well.  That does two things:  it will diminish bleeding during surgery and will also keep you comfortable for a few more hours after you awaken from anesthesia.  It does not diminish the depth of the general anesthesia.

Dr Jacobs

[Steve Dell]

Honestly, very few doctors will deviate from their standard procedures to accommodate a patient's request.  After all, the standard methods used by each surgeon are what he is comfortable in doing.  Furthermore, what is important is the results of the surgery -- you would not want to compromise that by asking a surgeon to be less comfortable in doing the procedure.

Yes, even under general anesthesia, most surgeons will inject local anesthetics as well.  That does two things:  it will diminish bleeding during surgery and will also keep you comfortable for a few more hours after you awaken from anesthesia.  It does not diminish the depth of the general anesthesia.

Dr Jacobs

Are there machines to detect if you have gone too far under or not far enough under that is commonly used or do they just eye ball it from your weight?

My concern with anesthesia is that I will be aware of what is going on or might die as a result of it.

Has there been any new advancements lately that makes it safer than it use to be ?

Thanks

[George Pope, M.D.]

There are monitors that help the anesthetist (anesthesiologist) know where you are with regard to level of anesthesia.  One very important monitor that we use measures your expired gas concentration.  It's not enough to know what percentage of what you're breathing IN is the anesthetic agent (as opposed to Oxygen, Nitrogen, etc).  It's important to know what percentage of the EXHALED gases is the anesthetic agent.  That way the anesthesiologist is sure that you're asleep and not feeling anything. 

I prefer general anesthesia, but I still inject fluid into the chest tissues that provides some local anesthesia and some vasoconstriction to minimize bleeding.  If a patient is really wary about a general anesthetic, I will perform the surgery under local with intravenous sedation by the anesthesiologist.  But the general anesthesia agents we use now are so safe, with such a fast wakeup, that my patients do very well and wake up quickly with no recall. 

Dr. Jacobs is right: every surgeon will have a method that he's comfortable with.  But most surgeons are happy to discuss options with a patient and come to a reasonable agreement.

Postoperative nausea and vomiting (actually has an acronym: PONV) is a big issue in anesthesia, and every precaution is taken to help prevent it.  A number of medications are given prior to the surgery, and the incidence of PONV is very low in young, healthy males after a general anesthetic.

Dr. Pope, MD

[rocksteady]

I received local anesthesia treatment during my procedure that only removed breast tissue from my nipples. It went fine. The only real pain came after my surgeon dug too deep.