Fear of anesthesia

[dustman]

Hi docs,
 I am terribly afraid of some horrible complication happening during my surgery. I have a pretty large gland and need a good bit of lipo.

Is the deep sedation safer than general anesthesia.  Will i be awake but not care? How does that work?
Have any of you had patients die from gynecomastia surgery? HOw bad will the pain be?

[Dr. Elliot Jacobs]

I do virtually all my surgery under intra-venous sedation (twilight sleep) anesthesia, which is administered by a separate, board certified anesthesia MD.  We have worked together for over 20 years -- and we are a very good team.

The job of the anesthesia doctor is to keep you comfortable and keep you safe while I concentrate on performing the surgery. 

Many of my patients state that the "few minutes they were under"  (actually over an hour of time) were very comfortable and relaxing. You are sleeping gently -- no pain, no awareness, eyes closed -- and you will awaken quickly and refreshed, with no nausea or hangover.

The answer to your question:  the anesthesia, for many of my patients, is the best part of the surgery.  And no, I have never had a death or even an emergency during this type of anesthesia.

Dr Jacobs

[Litlriki]

Dr. Jacobs makes an important point: He and his anesthesiologist have been working together for 20 years.  That interaction is important.

I work at a hospital with an anesthesia residency program, so although the attending anesthesia staff are people I've worked with for over 10 years, the residents come and go.  Some are better than others, though most are actually very good.  If the patient desires sedation as opposed to a general anesthetic, I am fine with that.  The main difference is the use of a device called a "laryngeal mask airway" or LMA, which provides for a protected airway with a light general anesthetic.  This often makes the anesthetic a little "easier" for our team, but if the patient requests "twilight sleep" instead, I leave that up to the team. 

I have never had a death or major complication related to anesthesia during gynecomastia surgery.

Rick Silverman

[dustman]

Thank you for your wonderful responses. I would love to travel to see one of you, however i am not able to leave town for this procedure.

My doctor says that general with an LMA is what he prefers, and that its safer than sedation because it isnt 'on the line' like sedation with regard to almost being so sedated breathing is impared.

He mentioned with me being a bigger guy with a thick neck, an lma is what we should request the anesthesiologist to use. Does this sound reasonable?

My main scare is of having a heart attack while inducing anesthesia or something cardiovascular related as that seems to be an anesthesia side effect from what i read... Web md will scare the crap out ofyou!

I am just so terribly scared to be cut on and put under, as ive never been put under in my life. But i absolutely cant stand the pain from my gyne anymore. I already have thoracic kyphosis from it because i used to hunch over and try to hide it in my adolescence.

It sounds like i just need to decide and do it... Your advice means more than you will ever know.

[Litlriki]

A general with an LMA is very safe.  You breathe on your own throughout the procedure, including during induction of the anesthetic.  If you have a thick neck or there is any concern over airway management, elective placement of the LMA is a good idea, rather than having to do it quickly during the procedure when there is a problem. 

If it helps to relieve your anxiety, remember that it is safer for you to undergo a general anesthetic than it is to get into your car and drive to the hospital for the surgery.  Of course, now you'll just be nervous in the car...

RS