40% of Patients with General Anesthesia Experience ‘Brain Fog’ or postoperative cognitive dysfunction (POCD) . The best way to avoid “brain fog” or related to general anesthesia is not to use it at all.
Dr. Shu performs all cosmetic surgeries under local tumescent anesthesia with IV sedation only, which does not cause “brain fog” or postoperative cognitive dysfunction (POCD).
Local tumescent anesthesia revolutionizes many aspects of cosmetic and plastic surgeries. New generations of cosmetic and plastic surgeons have quickly adopted modern anesthesia for cosmetic surgeries.
Many people don’t know that the modern tumescent anesthesia was not invented by a plastic surgeon; it was actually invented by a dermatologist. Dr. Jeffrey Klein is a dermatologic surgeon practicing in California and invented the technique for tumescent local anesthesia and tumescent liposuction. Prior to 1986, all liposuction and cosmetic surgeries were done under general anesthesia and were associated with significant surgical blood loss and prolonged post-operative recovery of two or more weeks. Tumescent anesthesia combines saline, lidocaine and adrenaline in one solution. This mixture plumps and firms the tissue while it numbs the appropriate spot. Because the adrenaline acts as a vasoconstrictor, patients typically experience less blood loss. As well, lidocaine acts as a pain reliever and bacteria-reducing agent, which cuts down on the risk of post-op infection. Generally, patients have less bruising, reduced pain, and a faster recovery with tumescent anesthesia. General anesthesia comes with known risks including respiratory problems, stroke, heart attack and even rare cases, death. Tumescent anesthesia helps to avoid exposure to these potential issues, because unlike general anesthesia, tumescent anesthesia only numbs the area on which surgeon will operate.
Today, tumescent anesthesia is becoming the worldwide standard of cosmetic surgery. Not only does tumescent liposuction continue to be the world’s safest and most comfortable form of liposuction, but also it is now used in almost all cosmetic surgeries.
Another positive element of going this route is that you are awake during the procedure. Especially with breast augmentation, tumescent anesthesia enables patients to provide input about size and preferences as surgeon works. Following the breast augmentation, women often experience less initial discomfort and a shorter downtime than with the traditional option. It also provide some safety during liposuction, patient will tell if surgeon point the liposuction tube in the wrong direction in the body to avoid any potential perforation.
New data published in the February issue of Dermatologic Surgery, 2012 (Dermatol Surg. 2012;38:171-179)
The use of general anesthesia in conjunction with cosmetic surgery (i.e. liposuction) has been shown to significantly increase the risk for adverse events in office-based surgery. The new data published in the February issue of Dermatologic Surgery, 2012 (Dermatol Surg. 2012;38:171-179) states that two-thirds of deaths and three-quarters of hospital transfers were performed under general anesthesia as opposed to local anesthesia.
The study, derived from 10-year data from Florida and 6-year data from in Alabama, “confirms trends that have been previously identified in earlier analyses of this data,” write the authors, led by John Starling III, MD, from the Skin Cancer Center, Cincinnati, and the Department of Dermatology, University of Cincinnati, Ohio.
309 adverse events were reported in Florida, consisting of 46 deaths and 263 complications or hospital transfers, the majority of these as a result of cosmetic surgery done under general anesthesia. In Alabama, 52 adverse events were reported, consisting of 3 deaths and 49 complications or hospital transfers. 89% of these had a causal link to general anesthesia, and 42% were cosmetic surgeries. Pulmonary complications, including pulmonary emboli and pulmonary edema, were implicated in many deaths in both states.
Plastic surgeons were linked to nearly 45% of all reported complications in Florida and 42.3% in Alabama, write the researchers. No clear correlation was seen in regards to office accreditation, board certification, or hospital privileges.
According to commentary from C. William Hanke, MD, of the Laser and Skin Surgery Center of Indiana, three patient safety practices he recommends are “(1) Keep the patient awake!… 2) Think twice before supporting a patient’s desire for liposuction that is to be done in conjunction with abdominoplasty under general anesthesia…. 3) [B]e advocates for prospective, mandatory, verifiable adverse event reporting…[that] should include data from physician offices, ambulatory surgical centers, and hospitals to define and quantify problems that can be largely prevented and eliminated.”
The authors and editorialist were especially critical of liposuction done under general anesthesia. “No deaths occurred in the setting of local anesthesia. Liposuction under general anesthesia accounted for 32% of cosmetic procedure-related deaths and 22% of all cosmetic procedure-related complications,” the researchers write. (Dermatol Surg. 2012;38:171-179. Article abstract, Commentary extract.)
Dr. Shu is an advocate of local tumescent anesthesia, and he believes that local tumescent anesthesia continue to be a trend in cosmetic surgeries. Dr. Shu uses it in conjunction with oral and intravenous conscious sedation for almost all cosmetic surgeries in the ambulatory setting. The patient’s safety is our priority, and we are happy to see our patients safely go through the cosmetic procedures and surgeries and recover quickly.