August 13, 2025 • 43 mins
"Is the fear of anesthesia keeping you from getting the surgery you want?"
For many patients, it’s not the scalpel they fear—it’s the idea of “going under.” In this must-hear episode of Plastic Surgery Uncensored, Dr. Rady Rahban teams up with his long-time anesthesiologist, Dr. Houston, to answer the most common—and most misunderstood—questions about anesthesia. From the myths surrounding “twilight” sedation to the truth about general anesthesia safety, they unpack exactly what happens before, during, and after you’re asleep. What you’ll learn in this episode:
Anesthesia is the co-pilot of your surgery. The best surgical result means nothing without safety at every step. This episode arms you with the exact questions and knowledge to make sure your anesthesia care is as exceptional as your surgical care. If you’ve ever delayed surgery out of fear, or you know someone who has, this is the conversation that could change their mind—and keep them safe.
Share this with a friend, leave a review if you learned something new, and drop your anesthesia questions for a future Q&A.
For many patients, it’s not the scalpel they fear—it’s the idea of “going under.” In this must-hear episode of Plastic Surgery Uncensored, Dr. Rady Rahban teams up with his long-time anesthesiologist, Dr. Houston, to answer the most common—and most misunderstood—questions about anesthesia. From the myths surrounding “twilight” sedation to the truth about general anesthesia safety, they unpack exactly what happens before, during, and after you’re asleep. What you’ll learn in this episode:
- The three main types of anesthesia—local, twilight/conscious sedation, and general—and when each is truly appropriate.
- Why “twilight is safer” isn’t the whole truth (and when it can actually be riskier).
- The inside story on nausea prevention—how a layered, multi-drug approach makes recovery smoother.
- What you should always ask about your anesthesiologist’s credentials—and why team chemistry in the OR can save lives.
- How new medications like Ozempic can affect anesthesia safety and timing.
- The reality about rare fears like “waking up during surgery” or being “awake but paralyzed.”
- Why general anesthesia is far safer today than most people think, especially in healthy patients in accredited facilities.
Anesthesia is the co-pilot of your surgery. The best surgical result means nothing without safety at every step. This episode arms you with the exact questions and knowledge to make sure your anesthesia care is as exceptional as your surgical care. If you’ve ever delayed surgery out of fear, or you know someone who has, this is the conversation that could change their mind—and keep them safe.
Share this with a friend, leave a review if you learned something new, and drop your anesthesia questions for a future Q&A.
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Transcript
Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
Speaker 1 (00:10):
We have a fantastic episode for you.
Speaker 2 (00:13):
We get probably just as many questions to our practice
regarding anesthesia as we do plastic surgery, and that's understandable
because anesthesia for many patients is actually the main obstacle
to having surgery. As a surgeon, I don't even think
twice about it because I'm in the operating room and
I have experienced the wonders of anesthesia. But it has
(00:34):
become more and more evident to me that for a
lot of patients, the fear of anesthesia, and I use
the word fear because it really is fear, prevents them
from doing so many things they want to do. So
we have had done episodes before. Doctor Houston, Michael dear
friend of mine, and our head anesthesiologists have done episodes
in the past where we have sort of addressed the
(00:55):
basic concerns. But what we're going to do now is
we've asked for your question regarding anesthesia, and we're gonna
go ahead and answer them together and try to address
some of the more common concerns basically based on what
you guys have asked.
Speaker 1 (01:07):
So, mikel welcome to the show as always.
Speaker 3 (01:10):
Thanks.
Speaker 1 (01:11):
All right, So I put.
Speaker 2 (01:12):
These questions on this tiny little phone, so I'm going
to try to see if I can read them as
I'm closely approaching fifty. All right, so the first question
was from Juliana dot Velegas, and the question is is.
Speaker 1 (01:24):
Antithesia required to treat her question?
Speaker 2 (01:26):
We're about festoons and mail our bags. But the answer
the question should be is anesthesia required to do.
Speaker 1 (01:35):
Eye lid surgery? So I'll answer some of that for you.
It all depends.
Speaker 2 (01:40):
So some part of plastic surgery can be done under local.
So let's back up here and let's talk about the
hierarchy of anesthesia. We have local anesthesia where you're totally
awake and I numb you up.
Speaker 3 (01:53):
Right.
Speaker 1 (01:54):
Then we have.
Speaker 2 (01:55):
Local plus some type of IV stuff that you give.
Would that be conscousnation with be the next level? Consciousidation
is twilight and constantiation the same thing.
Speaker 3 (02:04):
For me, they're different. What's the difference between consciousidation is
you're still awake, You're still able to respond, but you
have something on board to where you're like, ooh, this
is nice, right and then and then twilight is what
twilight is. You're asleep, like you're asleep at your own house.
Speaker 1 (02:23):
Got it?
Speaker 2 (02:23):
So if I'm understanding this right, there's local, you're soup,
you're awake, they haven't altered your consciousness. Then there's this
subcategory which is from conscious sedation to twilight, where you're awake.
You don't you don't have a tube breathing on your behalf,
but we have the anti caesiologists giving you or the
doctor or the nurse whoever's giving you drugs that sort
(02:45):
of make you less alert and hence less fearful, less paid.
And then you have the ultimate, which is general anesthesia,
where you are completely put asleep and the anti caesiologist
then manages your breathing on your behalf.
Speaker 1 (03:00):
Yeah, so back to the question is can we do.
Speaker 2 (03:03):
Eyelid surgery under local? And it turns out that much
of the face and eyelids being one of them, you
can do under local.
Speaker 1 (03:13):
It's a little bit difficult, and the reason is there
are two parts the anesthesia.
Speaker 2 (03:18):
One is the pain part, which you can knock out
the pain, but the other is the comfort part, the
comfortableness of it, the experience for the patient. And so
I personally have chosen to do all of my surgeries
under general anesthesia, and the reason is because I have
a great anesthesiologist, right, I don't see there to be
(03:44):
much advantage.
Speaker 1 (03:44):
So this is where I'm going to turn you.
Speaker 2 (03:46):
A lot of patients have been under the impression, and
I'll get to that when we have the questions more
that general anesthesia is dangerous and as you march your
weight down and you go to conscious sedation or twilight,
somehow magically less dangerous. As a plastic surgeon, I actually
think the reverse personally, and I want to get your
(04:07):
comments on that, because it's not uncommon to patients like
I'll do this surgery but only if I'm not under general.
Speaker 1 (04:15):
Anesthesia, and I'm like, what does that have to do
with anything?
Speaker 2 (04:18):
So give me your thoughts on this philosophy that general
anesthesia is less or more dangerous.
Speaker 3 (04:25):
For most of the patients that would come here for surgery,
general anesthesia is completely safe for them. You know, they're
relatively healthy or we've gotten all of their health clearances,
and so general anesthesia is going to be safe for them.
We're going to be watching them carefully, we're going to
have everything planned out for them. And even for those
(04:49):
patients who were afraid ahead of time, afterwards are like,
this is great, you know right, What was I worried about.
Speaker 2 (04:55):
Is what the way I understood it, and you can
tell me otherwise.
Speaker 1 (05:00):
You are healthy. The assumption needs to be that you're healthy. Obviously.
Speaker 2 (05:02):
If you're not healthy, then this you can throw this
out the window. This is aesthetic surgery.
Speaker 1 (05:06):
You don't have to do any of this.
Speaker 2 (05:07):
You don't have a brain tumor, you don't have an
aertic aneurysm. We're choosing to do this, so, as you mentioned,
we are very stringent on our criteria that we check
to make sure you're healthy. Once we've checked healthy, then
whether you're under general honestheesia where you're completely asleep and
unaware and you wake up, you're like, holy shit, is
it over? Versus if you are conscious conscious nation or
(05:31):
twilight where you're kind of like groggy, you don't remember it.
It's kind of like what we do for colonoscopies. My
understanding was that for an anesthesiologist it's more difficult because
you have to stay, you have to keep the patient
in a very small bandwidth.
Speaker 1 (05:47):
If they are too.
Speaker 2 (05:48):
Awake, they move and they uncomfortable, and they're uncomfortable and
they make the surgery for me miserable and if they're
too deep, they're not going to breathe because there's no
two in their throat. Right, So whereas with general anesthetic,
I'm not saying that it's not difficult or it's not relevant.
Speaker 1 (06:06):
You have a too protecting the breathing.
Speaker 2 (06:07):
So even if you're overly done or underdone in your breathing,
the machine is breathing for you. Would conscious tidation if
antithesiologist isn't paying attention to you and you're not monitored
and you dip too far in the oh we gave
them too much and they stopped breathing. I was under
the impression that that's more concerning than general asthesia.
Speaker 3 (06:26):
Uh, that that aspect of it can be true. Yeah,
it can be true at times. Yeah, I'm I do
consciousnation all the time and other settings. But yes, it's
it can be more fine tuning.
Speaker 2 (06:40):
Would you would you think do you think that a
for an average anesesiologist, right, is it easier to do
general anesthesia? In other words, the concern is the patients
whore out there were going to any facility between here
and Timbuckton. They don't know the level of anesthesia provider.
It could be an antithesiologist. It could be a CRN
egg for god knows, it could be.
Speaker 1 (07:00):
Just a nurse pushing propofol.
Speaker 2 (07:02):
And so the question I have is I almost feel
like general anesthesia is a safer type of anesthesia for
undertrained people, and conscious sedation requires more skill because you
have to fly in a certain zone.
Speaker 1 (07:17):
Is that not true or is that not accurate?
Speaker 3 (07:19):
I would agree with that for the most part.
Speaker 2 (07:22):
Right, don't you think if you're not the best antithesiologist,
it's easier for you to do general anesthesia.
Speaker 3 (07:28):
Probably probably a little bit safer, righttances, So anyway, for me,
more control, more control, so you have more safety net.
Speaker 2 (07:39):
Yeah, So this generally answers the question regarding conscious sedation.
So the question was can you do eyelids under local?
Local means no additional medication. The answer is you can
do some parts of it. Yes, the upper eyelid you could.
Speaker 1 (07:52):
For example, the lower eyelids.
Speaker 2 (07:53):
You won't be able to do because it's just too
much pressure on the island. But by and large there's
people doing many fail under local. So the answer you
can do it. I don't like to do it because
I feel that I don't have control.
Speaker 1 (08:07):
If you were to have.
Speaker 2 (08:08):
An issue like bleeding. Now you're awake, you're bleeding. There's
no antithesiologist here. So I prefer doing all of my
cases under general anesthesia with and kick ass antithesiologist by
my side, so that she's taking care of the anesthesia
while I can focus on you and you are asleep
(08:28):
and safe. To Heidi, yeah, tahitis, as we would say. Okay,
So that answers that question, probably in twenty other questions.
So okay, you'll like this question to me five asks,
I'm always nauseated after anthesia for forty eight hours. Any tips,
and this couldn't be more relevant because.
Speaker 3 (08:46):
Because to to me A five and everybody else out there,
I'm really prone to nausea myself, like right big time.
Speaker 2 (08:54):
So she's highly sensitive. Yes, as all anethesiologists should care
about nausea, but nowtly, if it's something that happens to you,
you're more heightened awareness. So let's go through all the
things you do from the basic and you just keep
working your way down to help with nausea. Now, I'm
going to mention this, if you're prone to nausea, you
(09:15):
will be nauseous. I think that irrespective of all seventy
seven maneuvers, if you're truly the goal is to get
it so that it's manageable and not overwhelming. But let's
hear what are our steps for nausea?
Speaker 3 (09:30):
Yeah, so probably the first step is going to be reassurance.
I know that I understand what you're going through. That
either you've had it before, or you know someone who's
had it, or you just read about it, and you
don't want that because nausea sucks, so lots of fluids.
I'll give you lots of fluids. You know, you can't
eat or drink anything before surgery, so you're counting on
(09:51):
us to give it back to you, and I'll do that.
I have about six different medications that I give, including
additional propofil towards the end of the surgery and anything
else they think they want to know the specific medications.
Speaker 2 (10:11):
So yeah, the first first thing we do, as you
had said, we extra hydrate you because as you as
it is, when you come in, you're dehydrated. You haven't
had anything to drink or eat since midnight or then
or even earlier. And when you're dehydrated in general, you're
prot nausea. So we slam you with fluids so that
you are super tanked up and very full of water,
(10:33):
because that helps. Secondly, we give you different drugs, so.
Speaker 3 (10:38):
They're all different, right.
Speaker 1 (10:39):
There are different approaches or different avenues.
Speaker 3 (10:42):
Really important. There's also specific drugs that I will not
give you because they are known to cause naseas. Perfect
point in giving them to.
Speaker 1 (10:52):
Right, So first we we tank you with fluids.
Speaker 2 (10:54):
Here are the drugs to avoid. And you tell you're antithesiologists. Hey,
I'm prone to nausea. Makes sure you don't give me
de dems one of them.
Speaker 3 (11:04):
That's probably the number one one. Yeah, I'm not going
to give you extra dilau it. I'll give you other
pain medications.
Speaker 2 (11:11):
Medications are super super.
Speaker 1 (11:16):
Nausea provoking.
Speaker 2 (11:17):
You need them because you can't do the surgery without them.
But there are some that are less and some that
are more. Would you say fentanyl is less nausea provoking?
Speaker 3 (11:25):
Es?
Speaker 2 (11:25):
Right, So you want in general stay away from demrol.
It's like the devil when it comes to nausea if.
Speaker 3 (11:30):
You're really prone. Correct.
Speaker 2 (11:31):
Now, on the flip side, here are the medications we
give you, and we give you various medications at all
directions to try to knock down your nausea from different
if you will entry points.
Speaker 1 (11:42):
One of them is.
Speaker 3 (11:43):
Zofranzo Friangland decadron.
Speaker 2 (11:47):
Decadron is a steroid. We give you a steroid to
knock down your nausea.
Speaker 3 (11:51):
What else pepsid to reduce the pe ad.
Speaker 2 (11:54):
It reduces your acid production, which can again anesthesia causes
slowing of your gut, and so you then often have
a buildup of acid, and so we want to knock
down the acid.
Speaker 1 (12:04):
What else the SCO patch.
Speaker 2 (12:06):
We give you a scapalme patches. It's kind of like dramamine.
Is kind of like dramamine. It's sort of a longer,
it's a it's a when you know, for motion sickness.
We put a patch on you which then will carry
you through after surgery.
Speaker 3 (12:18):
Christ and then this is not directly anti nausea, but lytokane.
So now I've started giving an additional dose of small
additional dose of ivy lytocane to help with the pain
control without having to ease more.
Speaker 2 (12:32):
Right, So the answer is I'm going to try to
reduce the amount of narcotic I give you so that
you don't get nauseous. The last one I remember is
you also you had mentioned it gives some propofol, which
is actually the drug we Michael Jackson drug that puts
you to sleep. But if you give a small amount
of it, it helps curtail your nausea. So as you
can see, there are lots of things you can do
(12:54):
for nausea, and your anethesiologist has to give a you
know about your nausea and saying, hey, you know, we
gave you a little zofran and you know you're gonna
get nauseous, because aside from nausea being a miserable experience,
it can.
Speaker 1 (13:08):
Ruin your results. If you were post off from a
face of and you're wretching, you're gonna pop a pop.
Speaker 3 (13:16):
A leak, You're gonna be gone leak.
Speaker 2 (13:19):
Tommy talk same thing, breast dog.
Speaker 1 (13:21):
You know, nausea is really important.
Speaker 2 (13:23):
Let's keep going here, all right, Manhattan Beach Fitness. Why
is everyone talking about twilight anesthesia being safer?
Speaker 1 (13:33):
Is that true? Hold on Mother of Wolves X.
Speaker 2 (13:39):
Why do some doctors use twilight and others use general
anesthesia with oxygen?
Speaker 1 (13:44):
Emmy underscore mock?
Speaker 2 (13:46):
Is there every case you you you'd operate on someone
with something other than deneral anesthesia. So that's why I
kind of went on a little bit of a tangent,
because I knew these questions were coming. So again, let's
just describe anesthesia in general. Local just some numbing medicine,
novacane for your teeth, etc. Then there's a middle racket
where you're not fully asleep and not awake, and you're
(14:09):
in this little buffer zone. It can be conscious sedation
or twilight, kind of like when you go get a colonoscopy.
Speaker 3 (14:15):
Correct.
Speaker 2 (14:16):
And then there's general anesthesia, where your anisesiologists is breathing
on your behalf because they've sedated you to a point
where you're deep enough where you're not moving and you're
not doing anything and theoretically not feeling anything, but certainly
you can't breathe. I in general, and this is a
matter of your doctor and your antithesiologist's preferences.
Speaker 1 (14:35):
Don't like the other methods.
Speaker 2 (14:36):
Because I do not believe they are safer for all
the reasons mentioned. I think the patient experience is a
thousand times better. When you're knocked down, what what's four hours?
Speaker 1 (14:49):
How did that happen?
Speaker 2 (14:50):
You're asleep and it's over, and God forbid there's an emergency,
I have much better control and I can do the
things I need to do. So I hope that answers
all a team of your questions. All right, let's take
a quick break.
Speaker 3 (15:02):
And definitely this is definitely that's true in regards to
the cases that we do here. Yeah, I mean, somebody
is going for like a bunion. Back yourself out, you
know you want to.
Speaker 1 (15:11):
So that's a great point that you make.
Speaker 2 (15:13):
We're addressing the needs of different anesthesia based on the
procedure being done. There are procedures that you absolutely have
to do under general anesthesia, there are procedures that you should.
Speaker 1 (15:25):
Absolutely do under local and then there.
Speaker 2 (15:27):
Are procedures that you could pick when a choice is available.
I tend to lean towards general anesthesia, but each doctor needs.
Speaker 1 (15:38):
To have a comfort zone with the procedure they do.
Speaker 2 (15:39):
If a doctor's been doing something and they've done a
thousand of them under consosidation, right then they know what
they're doing. Knock yourself out.
Speaker 4 (15:47):
Just speaking of which, Joan Rivers, Oh, yeah, was it
her issue that she was They were doing conscious sedation
in in an outpatient environment and they lost the airway and.
Speaker 3 (15:59):
Then I I don't know the exact details. You know,
full disclosure, but I thought I heard that there was
just not even there was not an amessz.
Speaker 2 (16:08):
There was there no So my understanding, don't quote me
on this.
Speaker 1 (16:12):
I will absolutely deny ever said this, even though it's.
Speaker 2 (16:14):
On camera that Joan Rivers went to. It was a
very prominent eed T clinic. She had some procedure to
a vocal courts or her lungs or her bronco, I
don't know what it was. And during the procedure, which
was conscious sedation if my understanding is correct, the airway became.
Speaker 1 (16:31):
Lost like she bled or she.
Speaker 2 (16:34):
Swelled up or I don't know, and there was not
someone there to intubate the patient and control the airway.
Speaker 1 (16:40):
And I believe that's how she died.
Speaker 2 (16:42):
Could be way off field, but it is that story
ish that makes me uncomfortable. So I don't even want
to go there. And so let's see what we got here.
We have PILLI, mom, is is it important to use
a board certifive anesthesiologist just like you recommend? And for
the plastic surgeons, should we ask the plastic surgeon about
(17:04):
the credentials of the ediszology or that the offensive surgeon
a fantastic question.
Speaker 1 (17:09):
God bless you, Billy Mom.
Speaker 2 (17:11):
So absolutely, you absolutely need to ask the plastic surgeon,
who the hell are you working with? Who's your anesthesiologist?
Is your surgery center accredited?
Speaker 1 (17:25):
Everything?
Speaker 2 (17:26):
You cannot go no longer can you go into any
kind of procedure blind anymore. Those days of paternalistic medicine
where you're like, well, my doctor said, so that's long gone.
It's not offensive, it's just being informed. And I don't
want to suggest that any version other than a board
certified editygologist is unacceptable. It's just board certified, and a
(17:47):
cazeologists is the lion in the jungle. Then it's not
board qualified. There's board certified, board qualified, not board certified
in my humble opinion. Then there's CRNA, and those CRNA's
are gonna listen to this. They're gonna get all bent
out of shape. But I didn't say you can't do
anesthesia with a CRNA. Absolutely accept as a matter of
(18:08):
fact it. They run many medical centers. I've done tons
of medical missions in Guatemala with CRNAs.
Speaker 1 (18:14):
They're amazing. So for all you CRNAs, don't get bent
out of shape.
Speaker 2 (18:17):
However, training wise and experience wise, there is a distinction
between a nurse practice, a nurse synesticist, and a board
CERTI fin antist geologist. Absolutely there is. Nevertheless, you need
as a patient to ask these questions, and depending on
what they tell you, you then can make your right. The
key is just to know who is there and what
(18:38):
is their training? Why, because there are shady people out there.
And if your doctor is offended, there's your answer, right,
there's the answer. If you're offended that your spouse questions
your your what is it your faithfulness because there's something
of concern, and you get all bent out of shape.
I think you did something illite. That's just the way
(19:00):
I see it. If you've done nothing wrong. I'm at
the airport, I'm Middle Eastern. You want to you want
to pat me down, put me in an X ray room,
knock yourself out?
Speaker 1 (19:09):
Oh my god? Why?
Speaker 2 (19:10):
Yes, we have blown up planes, so come check me out.
Speaker 3 (19:14):
You know what I mean like and it's just good
to know if they know anything about the people.
Speaker 1 (19:19):
That's thest oh last, but not least very important.
Speaker 2 (19:23):
I only work with the anti caesiologists that I've known
for seventeen years.
Speaker 1 (19:27):
The end, I don't use random antiseesiologists. That being said, the.
Speaker 2 (19:32):
Overwhelming majority of surgery is done in an outpatient and
surgery and hospital setting. The overwhelming majority of all surgery
is done are done with an anti caesiologist who happens
to be on.
Speaker 1 (19:44):
The schedule that day.
Speaker 2 (19:46):
The overwhelming majority are not done because the surgeon has
requested that particular antithesiologist, where that anti caesiologist works exclusively
with that surgery. That doesn't mean that it's not okay.
It means you go to the hospital and whoever's on
that days, that's the that's their day, or that's their room,
or that's who's there. But I think, in my opinion,
(20:08):
teams that work together, you're never gonna have a heart transplant,
where some random aniseesologists correct us, you're never going to
have any you know, a stroke.
Speaker 1 (20:17):
Burn burn you know.
Speaker 2 (20:18):
Teams are designed because the cardio, the anisologist, the surgeon,
the tech, and the nurse and a few other people
are all work together on.
Speaker 1 (20:25):
A regular basis.
Speaker 2 (20:27):
So I think it's important not only to know who
the anisiology is now, I think it's not only important
to know what their training is. I think it's important
to how often you work with them, because I can.
Speaker 3 (20:36):
Tell you that or at least similar type of case.
Speaker 1 (20:39):
Yes, like Minima, I can.
Speaker 2 (20:41):
Tell you that when Michael's on vacation, it's We're miserable,
right because we got it.
Speaker 1 (20:45):
We have no choice. We have to bring in people
that we've worked with. But it throws the whole thing
out of It throws the whole thing out of whack.
So I'm going on vacation, all right.
Speaker 5 (20:54):
Let's see here, Larumberah, Larombara. I'm presently taking ozempic to
lose weight, and I'm considering to do a temmi check
in the near future. Can my weight loss treatment have
an adverse effect with anesthesia?
Speaker 2 (21:12):
If so, how long do I need? So this is
a great question. Ozempic is ubiquitous. It's everywhere.
Speaker 1 (21:18):
It's taken over. It's like botox ozempic.
Speaker 3 (21:20):
I mean it's and all the and all the other
ones as well.
Speaker 2 (21:22):
Yeah, zempic will go Manjaro, and I'm sure tomorrow there'll
be seven more.
Speaker 1 (21:27):
So we don't know.
Speaker 3 (21:30):
We don't.
Speaker 1 (21:30):
We don't know exactly the anesthetic effects yet, or do.
Speaker 3 (21:34):
We They know they know a little bit, but definitely,
to be honest, the exact details escape me. I do
know this though, hold off for two weeks, right, And
what I was gonna say to you is it may
it may make some things more.
Speaker 1 (21:52):
Is it a gut related thing? It slows down your gut.
Speaker 3 (21:54):
End, goes into all of your metabolism and everything.
Speaker 1 (21:58):
So what I what I have understood, is.
Speaker 3 (22:01):
It slows some things down in.
Speaker 2 (22:02):
My understanding, and again it could be wrong, but I'll
tell you the bottom line of it. I think what
it does is comes out somehow causes paresis or slowing
down of your gut system. Yes, and as a result,
you're at a higher risk of asperating, which means that
you choke on your own vomit.
Speaker 1 (22:16):
That's not relevant.
Speaker 2 (22:17):
What's relevant is that we don't know enough and as
a result, our general philosophy when it comes to drugs
that you're taking that are not life necessary, what's a
life necessary you're in so it is life necessary. Your
hypertensive medication for your blood pressures, things that if you
don't take, you like you're going to not be healthy.
Speaker 1 (22:35):
We generally have you.
Speaker 2 (22:36):
Stop all those things, including supplements, two weeks prior. The
reason being is that's an adequate amount of time for
that thing to go through your system and not have
adverse effects. I assure you that if these drugs are
in the market in three, five, nine years, we will
know much more specific details of when, where, how, what.
(22:56):
But for the time being, our suggestion has historically been
two weeks hold off, one week after hold off, and
then go back and do whatever.
Speaker 1 (23:05):
It is that you were doing.
Speaker 3 (23:06):
Right, And of course if you have if you're a
particular person, you're into chronologist sends us a.
Speaker 2 (23:12):
Note that I mean, if somebody comes with a clearance
and we have data and science, but generally speaking mice philosophies,
do you need it to survive?
Speaker 5 (23:22):
No?
Speaker 1 (23:22):
Not really?
Speaker 2 (23:23):
Then stop it because I don't want to deal with it.
I don't Nothing's going to happen to you if you
don't take your clover loaf, you know, powder from the
you know whatever nonsense you're taking, Saint John's rue whatever.
All right, p D X five Can you still can
you still go on general anesthesia if you have a
(23:43):
sleep disort of like sleep apnea?
Speaker 1 (23:45):
Great question.
Speaker 2 (23:46):
Why We had a patient who recently sent us this question.
Actually her doctor canceled the surgery because she has sleep avenue,
which we think is nonsense. Sleep Apnea is a condition
in which, when you are sleeping for a host of reasons,
you get you go apnik. Ethnic means you stop breathing.
(24:07):
What does that mean?
Speaker 1 (24:08):
You're sleeping.
Speaker 2 (24:10):
And you stop breathing, But that's irrelevant. When you're having
general anesthesia, we're breathing for you. As a matter of fact,
it's the safest responds for sleep apnea. So sleep apnea
doesn't have anything to do with general anesthesia. Now, some individuals,
as a result of chronic, really bad sleep apnea, get hypertension,
(24:32):
they have a may pretension, they have.
Speaker 1 (24:34):
All these other conditions.
Speaker 3 (24:36):
And we definitely will watch those patients a little bit
more carefully than we even though we normally do throughout
and also post off sure, but it's not a reason
to not have surgery once you've gotten your pulmonary claim right.
Speaker 2 (24:51):
So what happens is you have a condition in this
instance is sleep apnea.
Speaker 1 (24:55):
In this condition, it's diabetes. In this condition, it's hypertension.
Speaker 2 (25:00):
We require your doctor manages that condition to say that
your condition not went away, but it's managed, it's under control.
Which case, when you're under Jennic Teacher, you're behaving the
same you were before you were.
Speaker 1 (25:14):
Under any teacher, you are stable.
Speaker 2 (25:16):
So sleep apnea, stable sleep apnea, well controlled sleep apnea,
in our estimation, is absolutely not a contraindication to having surgery.
We believe you will do just fine, assuming your doctor
is good, your post top care and recovery is good.
As a matter of fact, my producer Maria, who had
recently had a breast explantation, reduction, etc.
Speaker 1 (25:40):
She had sleep apnea, was.
Speaker 3 (25:41):
Honesty path it's not uncommon and.
Speaker 2 (25:45):
Was actually very concerned naturally and she a breeze. As
a matter of factur of sleep apne is better.
Speaker 1 (25:51):
But that's neither here nor there.
Speaker 2 (25:52):
Okay, jed underscore Dilz dills. What are the possible side
effects of Jenna? What are the risks of dying from
Generis seizure? So those are two separate questions. Let's address the.
Speaker 1 (26:04):
One that's easy, the risk of dying from general anesthesia.
Speaker 2 (26:07):
We don't know the exact statistic, but it's point zero
one million percent. In other words, it's super rare. You
are more likely to get run over by a drunk
driver statistically than die in general under general a estesia.
Caveat with a legit anesthesia provider in a legit environment
(26:28):
where you are healthy individuals. So let me rephrase that
you were healthy. You didn't walk into general anesthesia with
a high blood pressure of one ninety two.
Speaker 3 (26:37):
Or even if you're not one hundred percent and healthy.
But everything that can be disclosed was disclosed, right you
or someone in your family said hey, they have this, this, this, this, this,
and this. I'll alter what I'm going to do and
we'll keep you safe. Your risk is a little bit higher,
but it's still not oh you're gonna.
Speaker 1 (26:55):
Well well noted.
Speaker 2 (26:56):
One of the amazing parts that you guys don't understand
about any diesia is they go into manual mode.
Speaker 1 (27:03):
Let me explain this to you.
Speaker 2 (27:04):
When you get a DSLR camera, ninety nine point nine
percent of people put on auto and they shoot photos
and the camera is deciding your aperture, your shutter speed,
all these things because we don't know what we're doing.
When you get anesthesia, they took it on manual. The
anisesiologists regulates your blood pressure, regulates your heart, regulates your oxygenations,
(27:24):
opens up your lungs, puts in stuff that dilates things.
They literally micromanage everything about it is. So if you
end up coming in and you got into a car accident,
they don't have time to get you cleared. They take
care of you and you would do fine. So you
dying from general anesthesia is one of those urban legends.
Those are fears that people have, just like people are
(27:47):
afraid of dogs, people are afraid of flyind.
Speaker 1 (27:50):
They're not rooted in reality.
Speaker 2 (27:52):
Bugs, bugs you have in insects.
Speaker 1 (27:55):
So you will be fine, absolutely fine.
Speaker 2 (28:00):
Obviously don't go to some strip mall in the middle
of like Miami, you know, you know whatever, but generally speaking,
not a concern. Now, the other question, which was more
apropos what are the side effects of general anesthesia?
Speaker 3 (28:14):
So two of the main side effects, if left unchecked,
are like shivering and nausea, So those are two of
the main set ort.
Speaker 1 (28:25):
Term, right, short term.
Speaker 2 (28:26):
So what it is is, so let's just talk about
reactions and side effects.
Speaker 3 (28:31):
Oh and sleepiness once again short term. But you know,
after the fact, you're like, oh, we feel groggy, how
do you feel? I feel okay, I'm sleepy, I'm tired.
Speaker 2 (28:40):
So I'd like to qualify that that's a distinction between
reaction and side effect. The reaction is I had general
anesthesia and for twelve to forty eight hours, I am nauseous.
That's not a side effect. That's a reaction to the medications.
I am groggy. That's a reaction to the medications. And
(29:03):
immediately in recovery, which you won't ever remember, you might
have a little shiping.
Speaker 1 (29:07):
That's something that you won't even know.
Speaker 2 (29:09):
On the flip side, I can tell you two things
that I know of that is associated with anesthesia.
Speaker 1 (29:15):
Now these are actual side effects.
Speaker 3 (29:17):
None.
Speaker 2 (29:17):
I had my general anesthesia, and here are some things. One,
you may your period, your menstruation may be altered.
Speaker 3 (29:25):
Correct.
Speaker 2 (29:25):
So there are many many women who undergo general anesthesia
for a number of reasons and then they find out
that they missed their mental cycle, or it came early
and then it didn't come for four months.
Speaker 1 (29:35):
It throws off your story.
Speaker 3 (29:37):
And that's from the anesthesia and the surgery together. Your
body went through the stress of surgery.
Speaker 2 (29:42):
So that is NOD. The other is short term hair loss.
It is not uncommon. Again, this tends to be more
common in women than in men. And I think it's
hormone driven and it's not the actual anesthetic. But I
think it's just the shock of the system that you
lose hair for a period of time, and that hair
will always come back because it's not a long term
(30:05):
side effect. So in general general anesthesia, modern day general
anesthesia is phenomenal. It is really a truly remarkable component
of medicine that without which we would literally be doing
no robotic surgery, no spines discs, no into cranial electrode placement, no, no, no,
(30:28):
no nothing. It is the gateway to all of the
incredible face transplant. Right, All these things occur through general asteesia.
Speaker 1 (30:37):
All right, h.
Speaker 2 (30:42):
Bibblurd is it possible to wake up in the middle surgery?
Speaker 1 (30:46):
I love these questions.
Speaker 2 (30:47):
You guys ask great questions because on our last episode,
which was several years ago, we addressed these individual things
just because we knew people would be concerned. But I
like that you guys are asking it so again another
one of these. The reason why this show is so
relevant and why we do it we try to do
it often, is because these anesthesia is that thing we're
(31:07):
scared of, and it's almost ninety percent of it is
urban legend or or I.
Speaker 3 (31:12):
Heard or my friend told me so that her cousin.
Speaker 2 (31:17):
Right, that her cousin's gardner knew a guy in Guatemala.
So so there they're I'm gonna break this into two parts.
One is can you wake up during general anesthesia? And
the other I'm going to add is be awake and paralyzed.
Those are the two things that people are afraid of,
So let's address that.
Speaker 3 (31:35):
So I have never personally had a patient who has
had awareness during the anesthesia. But I have had patients
who've told us or told someone else that, like you said,
either they or their mom or their cousin or a
friend was awake during anesthesia, you know, at some point,
(31:58):
and it's they're not trying to get anything out of it.
I don't know whether it was true or not. You know,
I don't know if they're remembering something from a different
period mechanism.
Speaker 2 (32:09):
So take me through the mechanism of how a person
can be so it could be away.
Speaker 1 (32:13):
So as far as awake is very simple.
Speaker 2 (32:17):
You're not you're you're you're you're not deep enough the
way you're awake. Next thing you know, you're under generostesia.
There's levels of depression. So awake, totally awake, stop breathing.
You died, right, there's this, this, this's, this, this thing here,
And as the doctor gives you more anesthetic gases, injections, medications, narcotics,
(32:38):
your consciousness, your physiology is shutting down, your heart is
slowing down, your mental capacity is slowing down, and your
lung stop breathing.
Speaker 1 (32:47):
The whole purpose of generosteesia is to get you low.
Let's say this is the floor. You're up here. I mean,
you're miles away from.
Speaker 2 (32:54):
Being deceased, but they try and keep you close to
the surface so that you're safe. Now, it's possible that
during anesthesia, you're anesthesiologist runs you a little light. Remember,
their objective is to keep you not super low, but
low enough where they can do the surgery safely and
bring you back out.
Speaker 3 (33:13):
And it can also happen to where the anesthesia provider
is administering the correct amount and something is blocked to
where it wasn't getting through or something right.
Speaker 2 (33:23):
So that's a very good comment. Let's say there, remember
how do we get all the drugs in you? Aside
from breathing them. Some of them are intravenious. Let's say
your elbow is bent and you know they're giving you
the drugs and for a very short period of time.
But this idea that you're awake, you don't go from
geno anesthesia and then you're like, oh my god, you
should see people in recover. It takes thirty minutes to
(33:44):
come to even after they shut everything off. So what
is possible is that you get a little light and
during surgery patients will start moving or bucking. They have
no recollection of it. And then the anthesiologists who's there,
they're not down the stree, who's there, goes, oh, okay,
this patient is metabolizing more than I had anticipated.
Speaker 1 (34:05):
There they work out.
Speaker 2 (34:07):
They have a gene that eats through it more and
they just churn up the dose. But it really is very,
very very unlikely that you'll just wake up from antices. Now,
talk to me about this awake but paralyzed component, because
this is like the biggest fear of all patients in
the world. And every so often you watch one of
these Late nine shows and a guy's like, I was
awake and they were hammering my femur and I couldn't
(34:29):
tell them anything, and everyone's like never having at a
CJ again.
Speaker 3 (34:33):
But I'm glad that she said hammering their famer because
I have heard of that, and it might be some
of those circumstances might be someone who's having say a
C section, so they got a spinal or an epidural
and so they can't feel it, thank goodness. But up
here they were given something, but now it kind of
(34:54):
wore off near a little bit awake or for me,
replacement or a hip replacement or a foot surgery to
where they get, you know, temporarily intentionally paralyzed and numbed
on their lower extremity and then a little medication up
here to be sedated, and then it may have worn off.
Speaker 2 (35:14):
So so let's chat about that, because I think that
is exactly what happens. So we talked about local conscious
sedation generlineicesia. We left out spinals, right, epidurals and spinals
and what that is, and nerve blocks and nerve blocks,
which that means is that you're at a caesiologist takes local,
the local you put here around your eye or your
(35:34):
lip or whatever, and takes local and sticks it in
the spinal canal and numbs everything below that level down.
So a very common one is an epidural form se
sex section. It's like the standard way of doing things
they don't want to knock you out. You are awake,
but you feel nothing from the you know, rib cage down. Okay,
(35:57):
but it is very common, not in a sea section,
but for other cases like orthopedias where they are traumatic,
right that they give you drugs that sedate you. So
you're conscious sedation on the top of your body and
you are nerve blocked or spinal epidural on the lower
part of your body. And what happens is that you
(36:18):
kind of lighten up and that you wake up and
you're like, oh my god, I'm paralyzed. Yeah, you're paralyzed.
That was the procedure, and I'm awake. So that all
being said, the total number of such cases is minor,
if at all. Ever, so I certainly would not go
get my whatever fix because I'm afraid of it. I
(36:40):
think that leaves us with the last question. And look
at that where somebody put this thing together and it's brilliant.
Speaker 1 (36:48):
So it says.
Speaker 2 (36:52):
Mamo office, Mama five corrected. Can tell me to speaker
formed with an epidural and sedation versus going under general anesthesia.
So that was like, it couldn't have been a better
like lag, So can you do an epidural based tummy chuck.
Speaker 3 (37:13):
Let's let's say we were in a different setting or
something like that. Could it be done? I would say
it could be done.
Speaker 1 (37:21):
You can't paralyze the muscle.
Speaker 3 (37:22):
Hm hmm. Well, well are they having the dr repair?
Speaker 2 (37:28):
Well, I mean just elevating the muscle flap, just elevating
the flap with this.
Speaker 1 (37:32):
This is right right?
Speaker 3 (37:34):
I see. So there you have it. What was the
name that can't?
Speaker 2 (37:38):
Yeah, mumma five, let me explain you.
Speaker 1 (37:41):
Yes and no? Okay, yes, your anes caesiologists can.
Speaker 2 (37:45):
Put Can you explain any difference between a spinal and
an epidural?
Speaker 1 (37:50):
Real quick?
Speaker 3 (37:50):
Spinal goes in, we're putting the It goes.
Speaker 2 (37:53):
In into the canal, and the epidural is on the
outside of.
Speaker 3 (37:57):
It, the outside. So one is past the dura. Well, yes,
past the dura and one is outside.
Speaker 2 (38:05):
Of Okay, how does that? What difference does that make
in terms of the anesthetic? Is one shorter, one longer?
Does one goes some?
Speaker 3 (38:11):
One?
Speaker 1 (38:11):
One is?
Speaker 3 (38:12):
One is one. If you're giving us the spinally, you're
giving a much smaller dose and it's going to come on,
but it's gonna what's going to wear off? Usually depending
on which exactly local anesthetic you use more quickly. One
is designed usually to where you can place a catheter
for the epidural, and it's much larger amounts and dosing,
(38:36):
and it can.
Speaker 2 (38:36):
So you use a spinal for a shortcase and use
an epidural for a longer case.
Speaker 1 (38:40):
Is that is that how you choose?
Speaker 3 (38:42):
That's one that's one way to Yeah.
Speaker 2 (38:44):
So, and let's just say it's an epidural for the
tummy chuck. If we were we wouldn't do it with
a spinal wear off. It's a three hour kise, so
we put an epidural. And yes, you're a cesiologies can
make it so that you are awake and you feel
nothing from your rip cage down right, because your concern
is anything lower than your diaphragm, right, that's the area.
(39:05):
So you cannot have this chart out right because you
do it baby delivery and they don't feel anything.
Speaker 1 (39:09):
They're abdoment.
Speaker 2 (39:09):
So yes, the problem you're going to run into is
that in order to do in a tummy tuck, my
tummy tucks, I need the muscles paralyzed because when I'm
opening the abdomen with my cattery, the muscles are twitching,
and I need the doctor Houston to give the muscle
(39:30):
relaxing so that there's no twitching of the muscle. The
minute she gives you muscle relaxes, you stop breathing because
she's knocking out all the muscles, and that includes your
breathing muscles. Yeah, I can't open without muscle paralysis. And
I can't repair your separated muscles your diastasis, which is
(39:50):
ninety percent of tummy tucks. So yes, you couldn't have it.
I know there's doctors could do breast dogs, but it's
the same issue with it because I need aalysis of
the muscles. So I don't think it's a very effective way.
And the only reason people are asking is because they're
afraid of general ansty right, right, They're afraid.
Speaker 1 (40:08):
Of like, Okay, how do I avoid this horrible thing? Well,
that's it, ladies and gentlemen. You guys have done an
excellent job.
Speaker 2 (40:15):
We thought we try this approach to anesthesia dialogue as
opposed to our last approach.
Speaker 1 (40:21):
Which was just sort of a boom boom boom list.
Speaker 2 (40:23):
I kind of liked it because you guys did a
good job and I asked some good questions all right.
Any parting advice for those people listening at home who
are just dying to go get some surgery.
Speaker 1 (40:34):
Done in there freaking out about anesthesia.
Speaker 3 (40:36):
Yeah, just continue to do your homework from reliable sources,
from reputable sources, not just like some random source.
Speaker 2 (40:48):
So TikTok is that reliable or right?
Speaker 3 (40:52):
So and then yeah, you can look at the American
Society of Anesthesiology websites or something like that and get
reliable informing.
Speaker 2 (41:01):
Yeah. I think the reality is that the same amount
of emphasis and energy you placed at selecting your surgeon
that's sort of oh my god, this guy's gonna cut
me open or this woman is going to you should
be really inquiring about the person putting you to sleep,
because they are the co captain of this experience.
Speaker 1 (41:18):
And all too often patients go in and they just
sign over to the doctor and then they just assume
that the rest of the team is going to be great,
and it just isn't the case. And the question is
why not? And the answer is money, Because the other
members of the team are additional costs, and so if
(41:40):
the doctor wants to be greedy and it is in
their best interest to keep as much money as possible,
they will hire perhaps maybe less effective, less qualified, more affordable.
Speaker 3 (41:54):
Or like you said, to where there might be a
very you know, perfectly acceptable antesesia provider, but they just
never even work with that person before at that place, right,
so they don't know where everything is, or it's a
little uncomfortable, or the dynamic is like, oh.
Speaker 2 (42:11):
I really think the fact that we work together three
times a week, the dynamics and the smoothness, it's so
well orchestrated that when we're in the operating room, god forbid,
God forbids.
Speaker 1 (42:23):
Something were to go wrong, the.
Speaker 2 (42:26):
Speed in which we can address it is going to
be far greater than if it's your first time in
a new environment. You've never been at this facility, you
and the doctor have never interacted before. I do think
that creates a huge issue. Nevertheless, the most important thing
is anesthesia is safe. That is the key thing for
you to take home. All right, guys, Well, thank you
so much for coming. I very much appreciate it.
Speaker 1 (42:47):
I'm sure the patients will love this episode. As always.
Speaker 2 (42:49):
Two things on as I'd like to impart before we
get off. One, if you like to show go right
something nice. People like to hear nice things. If you
have nothing nice to say, I don't write anything.
Speaker 1 (43:01):
And then the.
Speaker 2 (43:02):
Second thing is if you love someone and you think
that they might want to do esthetic surgery or they're
planning on having surgery, then as always share this show
with them because you'll never know till it's too late
that they had something done, and you're like, God, if
I had only known. So as always, I'm your host,
Doctor Roddy Rohnds signing off until next week on plastic
(43:22):
Surgery Uncensored
We have a fantastic episode for you.
Speaker 2 (00:13):
We get probably just as many questions to our practice
regarding anesthesia as we do plastic surgery, and that's understandable
because anesthesia for many patients is actually the main obstacle
to having surgery. As a surgeon, I don't even think
twice about it because I'm in the operating room and
I have experienced the wonders of anesthesia. But it has
(00:34):
become more and more evident to me that for a
lot of patients, the fear of anesthesia, and I use
the word fear because it really is fear, prevents them
from doing so many things they want to do. So
we have had done episodes before. Doctor Houston, Michael dear
friend of mine, and our head anesthesiologists have done episodes
in the past where we have sort of addressed the
(00:55):
basic concerns. But what we're going to do now is
we've asked for your question regarding anesthesia, and we're gonna
go ahead and answer them together and try to address
some of the more common concerns basically based on what
you guys have asked.
Speaker 1 (01:07):
So, mikel welcome to the show as always.
Speaker 3 (01:10):
Thanks.
Speaker 1 (01:11):
All right, So I put.
Speaker 2 (01:12):
These questions on this tiny little phone, so I'm going
to try to see if I can read them as
I'm closely approaching fifty. All right, so the first question
was from Juliana dot Velegas, and the question is is.
Speaker 1 (01:24):
Antithesia required to treat her question?
Speaker 2 (01:26):
We're about festoons and mail our bags. But the answer
the question should be is anesthesia required to do.
Speaker 1 (01:35):
Eye lid surgery? So I'll answer some of that for you.
It all depends.
Speaker 2 (01:40):
So some part of plastic surgery can be done under local.
So let's back up here and let's talk about the
hierarchy of anesthesia. We have local anesthesia where you're totally
awake and I numb you up.
Speaker 3 (01:53):
Right.
Speaker 1 (01:54):
Then we have.
Speaker 2 (01:55):
Local plus some type of IV stuff that you give.
Would that be conscousnation with be the next level? Consciousidation
is twilight and constantiation the same thing.
Speaker 3 (02:04):
For me, they're different. What's the difference between consciousidation is
you're still awake, You're still able to respond, but you
have something on board to where you're like, ooh, this
is nice, right and then and then twilight is what
twilight is. You're asleep, like you're asleep at your own house.
Speaker 1 (02:23):
Got it?
Speaker 2 (02:23):
So if I'm understanding this right, there's local, you're soup,
you're awake, they haven't altered your consciousness. Then there's this
subcategory which is from conscious sedation to twilight, where you're awake.
You don't you don't have a tube breathing on your behalf,
but we have the anti caesiologists giving you or the
doctor or the nurse whoever's giving you drugs that sort
(02:45):
of make you less alert and hence less fearful, less paid.
And then you have the ultimate, which is general anesthesia,
where you are completely put asleep and the anti caesiologist
then manages your breathing on your behalf.
Speaker 1 (03:00):
Yeah, so back to the question is can we do.
Speaker 2 (03:03):
Eyelid surgery under local? And it turns out that much
of the face and eyelids being one of them, you
can do under local.
Speaker 1 (03:13):
It's a little bit difficult, and the reason is there
are two parts the anesthesia.
Speaker 2 (03:18):
One is the pain part, which you can knock out
the pain, but the other is the comfort part, the
comfortableness of it, the experience for the patient. And so
I personally have chosen to do all of my surgeries
under general anesthesia, and the reason is because I have
a great anesthesiologist, right, I don't see there to be
(03:44):
much advantage.
Speaker 1 (03:44):
So this is where I'm going to turn you.
Speaker 2 (03:46):
A lot of patients have been under the impression, and
I'll get to that when we have the questions more
that general anesthesia is dangerous and as you march your
weight down and you go to conscious sedation or twilight,
somehow magically less dangerous. As a plastic surgeon, I actually
think the reverse personally, and I want to get your
(04:07):
comments on that, because it's not uncommon to patients like
I'll do this surgery but only if I'm not under general.
Speaker 1 (04:15):
Anesthesia, and I'm like, what does that have to do
with anything?
Speaker 2 (04:18):
So give me your thoughts on this philosophy that general
anesthesia is less or more dangerous.
Speaker 3 (04:25):
For most of the patients that would come here for surgery,
general anesthesia is completely safe for them. You know, they're
relatively healthy or we've gotten all of their health clearances,
and so general anesthesia is going to be safe for them.
We're going to be watching them carefully, we're going to
have everything planned out for them. And even for those
(04:49):
patients who were afraid ahead of time, afterwards are like,
this is great, you know right, What was I worried about.
Speaker 2 (04:55):
Is what the way I understood it, and you can
tell me otherwise.
Speaker 1 (05:00):
You are healthy. The assumption needs to be that you're healthy. Obviously.
Speaker 2 (05:02):
If you're not healthy, then this you can throw this
out the window. This is aesthetic surgery.
Speaker 1 (05:06):
You don't have to do any of this.
Speaker 2 (05:07):
You don't have a brain tumor, you don't have an
aertic aneurysm. We're choosing to do this, so, as you mentioned,
we are very stringent on our criteria that we check
to make sure you're healthy. Once we've checked healthy, then
whether you're under general honestheesia where you're completely asleep and
unaware and you wake up, you're like, holy shit, is
it over? Versus if you are conscious conscious nation or
(05:31):
twilight where you're kind of like groggy, you don't remember it.
It's kind of like what we do for colonoscopies. My
understanding was that for an anesthesiologist it's more difficult because
you have to stay, you have to keep the patient
in a very small bandwidth.
Speaker 1 (05:47):
If they are too.
Speaker 2 (05:48):
Awake, they move and they uncomfortable, and they're uncomfortable and
they make the surgery for me miserable and if they're
too deep, they're not going to breathe because there's no
two in their throat. Right, So whereas with general anesthetic,
I'm not saying that it's not difficult or it's not relevant.
Speaker 1 (06:06):
You have a too protecting the breathing.
Speaker 2 (06:07):
So even if you're overly done or underdone in your breathing,
the machine is breathing for you. Would conscious tidation if
antithesiologist isn't paying attention to you and you're not monitored
and you dip too far in the oh we gave
them too much and they stopped breathing. I was under
the impression that that's more concerning than general asthesia.
Speaker 3 (06:26):
Uh, that that aspect of it can be true. Yeah,
it can be true at times. Yeah, I'm I do
consciousnation all the time and other settings. But yes, it's
it can be more fine tuning.
Speaker 2 (06:40):
Would you would you think do you think that a
for an average anesesiologist, right, is it easier to do
general anesthesia? In other words, the concern is the patients
whore out there were going to any facility between here
and Timbuckton. They don't know the level of anesthesia provider.
It could be an antithesiologist. It could be a CRN
egg for god knows, it could be.
Speaker 1 (07:00):
Just a nurse pushing propofol.
Speaker 2 (07:02):
And so the question I have is I almost feel
like general anesthesia is a safer type of anesthesia for
undertrained people, and conscious sedation requires more skill because you
have to fly in a certain zone.
Speaker 1 (07:17):
Is that not true or is that not accurate?
Speaker 3 (07:19):
I would agree with that for the most part.
Speaker 2 (07:22):
Right, don't you think if you're not the best antithesiologist,
it's easier for you to do general anesthesia.
Speaker 3 (07:28):
Probably probably a little bit safer, righttances, So anyway, for me,
more control, more control, so you have more safety net.
Speaker 2 (07:39):
Yeah, So this generally answers the question regarding conscious sedation.
So the question was can you do eyelids under local?
Local means no additional medication. The answer is you can
do some parts of it. Yes, the upper eyelid you could.
Speaker 1 (07:52):
For example, the lower eyelids.
Speaker 2 (07:53):
You won't be able to do because it's just too
much pressure on the island. But by and large there's
people doing many fail under local. So the answer you
can do it. I don't like to do it because
I feel that I don't have control.
Speaker 1 (08:07):
If you were to have.
Speaker 2 (08:08):
An issue like bleeding. Now you're awake, you're bleeding. There's
no antithesiologist here. So I prefer doing all of my
cases under general anesthesia with and kick ass antithesiologist by
my side, so that she's taking care of the anesthesia
while I can focus on you and you are asleep
(08:28):
and safe. To Heidi, yeah, tahitis, as we would say. Okay,
So that answers that question, probably in twenty other questions.
So okay, you'll like this question to me five asks,
I'm always nauseated after anthesia for forty eight hours. Any tips,
and this couldn't be more relevant because.
Speaker 3 (08:46):
Because to to me A five and everybody else out there,
I'm really prone to nausea myself, like right big time.
Speaker 2 (08:54):
So she's highly sensitive. Yes, as all anethesiologists should care
about nausea, but nowtly, if it's something that happens to you,
you're more heightened awareness. So let's go through all the
things you do from the basic and you just keep
working your way down to help with nausea. Now, I'm
going to mention this, if you're prone to nausea, you
(09:15):
will be nauseous. I think that irrespective of all seventy
seven maneuvers, if you're truly the goal is to get
it so that it's manageable and not overwhelming. But let's
hear what are our steps for nausea?
Speaker 3 (09:30):
Yeah, so probably the first step is going to be reassurance.
I know that I understand what you're going through. That
either you've had it before, or you know someone who's
had it, or you just read about it, and you
don't want that because nausea sucks, so lots of fluids.
I'll give you lots of fluids. You know, you can't
eat or drink anything before surgery, so you're counting on
(09:51):
us to give it back to you, and I'll do that.
I have about six different medications that I give, including
additional propofil towards the end of the surgery and anything
else they think they want to know the specific medications.
Speaker 2 (10:11):
So yeah, the first first thing we do, as you
had said, we extra hydrate you because as you as
it is, when you come in, you're dehydrated. You haven't
had anything to drink or eat since midnight or then
or even earlier. And when you're dehydrated in general, you're
prot nausea. So we slam you with fluids so that
you are super tanked up and very full of water,
(10:33):
because that helps. Secondly, we give you different drugs, so.
Speaker 3 (10:38):
They're all different, right.
Speaker 1 (10:39):
There are different approaches or different avenues.
Speaker 3 (10:42):
Really important. There's also specific drugs that I will not
give you because they are known to cause naseas. Perfect
point in giving them to.
Speaker 1 (10:52):
Right, So first we we tank you with fluids.
Speaker 2 (10:54):
Here are the drugs to avoid. And you tell you're antithesiologists. Hey,
I'm prone to nausea. Makes sure you don't give me
de dems one of them.
Speaker 3 (11:04):
That's probably the number one one. Yeah, I'm not going
to give you extra dilau it. I'll give you other
pain medications.
Speaker 2 (11:11):
Medications are super super.
Speaker 1 (11:16):
Nausea provoking.
Speaker 2 (11:17):
You need them because you can't do the surgery without them.
But there are some that are less and some that
are more. Would you say fentanyl is less nausea provoking?
Speaker 3 (11:25):
Es?
Speaker 2 (11:25):
Right, So you want in general stay away from demrol.
It's like the devil when it comes to nausea if.
Speaker 3 (11:30):
You're really prone. Correct.
Speaker 2 (11:31):
Now, on the flip side, here are the medications we
give you, and we give you various medications at all
directions to try to knock down your nausea from different
if you will entry points.
Speaker 1 (11:42):
One of them is.
Speaker 3 (11:43):
Zofranzo Friangland decadron.
Speaker 2 (11:47):
Decadron is a steroid. We give you a steroid to
knock down your nausea.
Speaker 3 (11:51):
What else pepsid to reduce the pe ad.
Speaker 2 (11:54):
It reduces your acid production, which can again anesthesia causes
slowing of your gut, and so you then often have
a buildup of acid, and so we want to knock
down the acid.
Speaker 1 (12:04):
What else the SCO patch.
Speaker 2 (12:06):
We give you a scapalme patches. It's kind of like dramamine.
Is kind of like dramamine. It's sort of a longer,
it's a it's a when you know, for motion sickness.
We put a patch on you which then will carry
you through after surgery.
Speaker 3 (12:18):
Christ and then this is not directly anti nausea, but lytokane.
So now I've started giving an additional dose of small
additional dose of ivy lytocane to help with the pain
control without having to ease more.
Speaker 2 (12:32):
Right, So the answer is I'm going to try to
reduce the amount of narcotic I give you so that
you don't get nauseous. The last one I remember is
you also you had mentioned it gives some propofol, which
is actually the drug we Michael Jackson drug that puts
you to sleep. But if you give a small amount
of it, it helps curtail your nausea. So as you
can see, there are lots of things you can do
(12:54):
for nausea, and your anethesiologist has to give a you
know about your nausea and saying, hey, you know, we
gave you a little zofran and you know you're gonna
get nauseous, because aside from nausea being a miserable experience,
it can.
Speaker 1 (13:08):
Ruin your results. If you were post off from a
face of and you're wretching, you're gonna pop a pop.
Speaker 3 (13:16):
A leak, You're gonna be gone leak.
Speaker 2 (13:19):
Tommy talk same thing, breast dog.
Speaker 1 (13:21):
You know, nausea is really important.
Speaker 2 (13:23):
Let's keep going here, all right, Manhattan Beach Fitness. Why
is everyone talking about twilight anesthesia being safer?
Speaker 1 (13:33):
Is that true? Hold on Mother of Wolves X.
Speaker 2 (13:39):
Why do some doctors use twilight and others use general
anesthesia with oxygen?
Speaker 1 (13:44):
Emmy underscore mock?
Speaker 2 (13:46):
Is there every case you you you'd operate on someone
with something other than deneral anesthesia. So that's why I
kind of went on a little bit of a tangent,
because I knew these questions were coming. So again, let's
just describe anesthesia in general. Local just some numbing medicine,
novacane for your teeth, etc. Then there's a middle racket
where you're not fully asleep and not awake, and you're
(14:09):
in this little buffer zone. It can be conscious sedation
or twilight, kind of like when you go get a colonoscopy.
Speaker 3 (14:15):
Correct.
Speaker 2 (14:16):
And then there's general anesthesia, where your anisesiologists is breathing
on your behalf because they've sedated you to a point
where you're deep enough where you're not moving and you're
not doing anything and theoretically not feeling anything, but certainly
you can't breathe. I in general, and this is a
matter of your doctor and your antithesiologist's preferences.
Speaker 1 (14:35):
Don't like the other methods.
Speaker 2 (14:36):
Because I do not believe they are safer for all
the reasons mentioned. I think the patient experience is a
thousand times better. When you're knocked down, what what's four hours?
Speaker 1 (14:49):
How did that happen?
Speaker 2 (14:50):
You're asleep and it's over, and God forbid there's an emergency,
I have much better control and I can do the
things I need to do. So I hope that answers
all a team of your questions. All right, let's take
a quick break.
Speaker 3 (15:02):
And definitely this is definitely that's true in regards to
the cases that we do here. Yeah, I mean, somebody
is going for like a bunion. Back yourself out, you
know you want to.
Speaker 1 (15:11):
So that's a great point that you make.
Speaker 2 (15:13):
We're addressing the needs of different anesthesia based on the
procedure being done. There are procedures that you absolutely have
to do under general anesthesia, there are procedures that you should.
Speaker 1 (15:25):
Absolutely do under local and then there.
Speaker 2 (15:27):
Are procedures that you could pick when a choice is available.
I tend to lean towards general anesthesia, but each doctor needs.
Speaker 1 (15:38):
To have a comfort zone with the procedure they do.
Speaker 2 (15:39):
If a doctor's been doing something and they've done a
thousand of them under consosidation, right then they know what
they're doing. Knock yourself out.
Speaker 4 (15:47):
Just speaking of which, Joan Rivers, Oh, yeah, was it
her issue that she was They were doing conscious sedation
in in an outpatient environment and they lost the airway and.
Speaker 3 (15:59):
Then I I don't know the exact details. You know,
full disclosure, but I thought I heard that there was
just not even there was not an amessz.
Speaker 2 (16:08):
There was there no So my understanding, don't quote me
on this.
Speaker 1 (16:12):
I will absolutely deny ever said this, even though it's.
Speaker 2 (16:14):
On camera that Joan Rivers went to. It was a
very prominent eed T clinic. She had some procedure to
a vocal courts or her lungs or her bronco, I
don't know what it was. And during the procedure, which
was conscious sedation if my understanding is correct, the airway became.
Speaker 1 (16:31):
Lost like she bled or she.
Speaker 2 (16:34):
Swelled up or I don't know, and there was not
someone there to intubate the patient and control the airway.
Speaker 1 (16:40):
And I believe that's how she died.
Speaker 2 (16:42):
Could be way off field, but it is that story
ish that makes me uncomfortable. So I don't even want
to go there. And so let's see what we got here.
We have PILLI, mom, is is it important to use
a board certifive anesthesiologist just like you recommend? And for
the plastic surgeons, should we ask the plastic surgeon about
(17:04):
the credentials of the ediszology or that the offensive surgeon
a fantastic question.
Speaker 1 (17:09):
God bless you, Billy Mom.
Speaker 2 (17:11):
So absolutely, you absolutely need to ask the plastic surgeon,
who the hell are you working with? Who's your anesthesiologist?
Is your surgery center accredited?
Speaker 1 (17:25):
Everything?
Speaker 2 (17:26):
You cannot go no longer can you go into any
kind of procedure blind anymore. Those days of paternalistic medicine
where you're like, well, my doctor said, so that's long gone.
It's not offensive, it's just being informed. And I don't
want to suggest that any version other than a board
certified editygologist is unacceptable. It's just board certified, and a
(17:47):
cazeologists is the lion in the jungle. Then it's not
board qualified. There's board certified, board qualified, not board certified
in my humble opinion. Then there's CRNA, and those CRNA's
are gonna listen to this. They're gonna get all bent
out of shape. But I didn't say you can't do
anesthesia with a CRNA. Absolutely accept as a matter of
(18:08):
fact it. They run many medical centers. I've done tons
of medical missions in Guatemala with CRNAs.
Speaker 1 (18:14):
They're amazing. So for all you CRNAs, don't get bent
out of shape.
Speaker 2 (18:17):
However, training wise and experience wise, there is a distinction
between a nurse practice, a nurse synesticist, and a board
CERTI fin antist geologist. Absolutely there is. Nevertheless, you need
as a patient to ask these questions, and depending on
what they tell you, you then can make your right. The
key is just to know who is there and what
(18:38):
is their training? Why, because there are shady people out there.
And if your doctor is offended, there's your answer, right,
there's the answer. If you're offended that your spouse questions
your your what is it your faithfulness because there's something
of concern, and you get all bent out of shape.
I think you did something illite. That's just the way
(19:00):
I see it. If you've done nothing wrong. I'm at
the airport, I'm Middle Eastern. You want to you want
to pat me down, put me in an X ray room,
knock yourself out?
Speaker 1 (19:09):
Oh my god? Why?
Speaker 2 (19:10):
Yes, we have blown up planes, so come check me out.
Speaker 3 (19:14):
You know what I mean like and it's just good
to know if they know anything about the people.
Speaker 1 (19:19):
That's thest oh last, but not least very important.
Speaker 2 (19:23):
I only work with the anti caesiologists that I've known
for seventeen years.
Speaker 1 (19:27):
The end, I don't use random antiseesiologists. That being said, the.
Speaker 2 (19:32):
Overwhelming majority of surgery is done in an outpatient and
surgery and hospital setting. The overwhelming majority of all surgery
is done are done with an anti caesiologist who happens
to be on.
Speaker 1 (19:44):
The schedule that day.
Speaker 2 (19:46):
The overwhelming majority are not done because the surgeon has
requested that particular antithesiologist, where that anti caesiologist works exclusively
with that surgery. That doesn't mean that it's not okay.
It means you go to the hospital and whoever's on
that days, that's the that's their day, or that's their room,
or that's who's there. But I think, in my opinion,
(20:08):
teams that work together, you're never gonna have a heart transplant,
where some random aniseesologists correct us, you're never going to
have any you know, a stroke.
Speaker 1 (20:17):
Burn burn you know.
Speaker 2 (20:18):
Teams are designed because the cardio, the anisologist, the surgeon,
the tech, and the nurse and a few other people
are all work together on.
Speaker 1 (20:25):
A regular basis.
Speaker 2 (20:27):
So I think it's important not only to know who
the anisiology is now, I think it's not only important
to know what their training is. I think it's important
to how often you work with them, because I can.
Speaker 3 (20:36):
Tell you that or at least similar type of case.
Speaker 1 (20:39):
Yes, like Minima, I can.
Speaker 2 (20:41):
Tell you that when Michael's on vacation, it's We're miserable,
right because we got it.
Speaker 1 (20:45):
We have no choice. We have to bring in people
that we've worked with. But it throws the whole thing
out of It throws the whole thing out of whack.
So I'm going on vacation, all right.
Speaker 5 (20:54):
Let's see here, Larumberah, Larombara. I'm presently taking ozempic to
lose weight, and I'm considering to do a temmi check
in the near future. Can my weight loss treatment have
an adverse effect with anesthesia?
Speaker 2 (21:12):
If so, how long do I need? So this is
a great question. Ozempic is ubiquitous. It's everywhere.
Speaker 1 (21:18):
It's taken over. It's like botox ozempic.
Speaker 3 (21:20):
I mean it's and all the and all the other
ones as well.
Speaker 2 (21:22):
Yeah, zempic will go Manjaro, and I'm sure tomorrow there'll
be seven more.
Speaker 1 (21:27):
So we don't know.
Speaker 3 (21:30):
We don't.
Speaker 1 (21:30):
We don't know exactly the anesthetic effects yet, or do.
Speaker 3 (21:34):
We They know they know a little bit, but definitely,
to be honest, the exact details escape me. I do
know this though, hold off for two weeks, right, And
what I was gonna say to you is it may
it may make some things more.
Speaker 1 (21:52):
Is it a gut related thing? It slows down your gut.
Speaker 3 (21:54):
End, goes into all of your metabolism and everything.
Speaker 1 (21:58):
So what I what I have understood, is.
Speaker 3 (22:01):
It slows some things down in.
Speaker 2 (22:02):
My understanding, and again it could be wrong, but I'll
tell you the bottom line of it. I think what
it does is comes out somehow causes paresis or slowing
down of your gut system. Yes, and as a result,
you're at a higher risk of asperating, which means that
you choke on your own vomit.
Speaker 1 (22:16):
That's not relevant.
Speaker 2 (22:17):
What's relevant is that we don't know enough and as
a result, our general philosophy when it comes to drugs
that you're taking that are not life necessary, what's a
life necessary you're in so it is life necessary. Your
hypertensive medication for your blood pressures, things that if you
don't take, you like you're going to not be healthy.
Speaker 1 (22:35):
We generally have you.
Speaker 2 (22:36):
Stop all those things, including supplements, two weeks prior. The
reason being is that's an adequate amount of time for
that thing to go through your system and not have
adverse effects. I assure you that if these drugs are
in the market in three, five, nine years, we will
know much more specific details of when, where, how, what.
(22:56):
But for the time being, our suggestion has historically been
two weeks hold off, one week after hold off, and
then go back and do whatever.
Speaker 1 (23:05):
It is that you were doing.
Speaker 3 (23:06):
Right, And of course if you have if you're a
particular person, you're into chronologist sends us a.
Speaker 2 (23:12):
Note that I mean, if somebody comes with a clearance
and we have data and science, but generally speaking mice philosophies,
do you need it to survive?
Speaker 5 (23:22):
No?
Speaker 1 (23:22):
Not really?
Speaker 2 (23:23):
Then stop it because I don't want to deal with it.
I don't Nothing's going to happen to you if you
don't take your clover loaf, you know, powder from the
you know whatever nonsense you're taking, Saint John's rue whatever.
All right, p D X five Can you still can
you still go on general anesthesia if you have a
(23:43):
sleep disort of like sleep apnea?
Speaker 1 (23:45):
Great question.
Speaker 2 (23:46):
Why We had a patient who recently sent us this question.
Actually her doctor canceled the surgery because she has sleep avenue,
which we think is nonsense. Sleep Apnea is a condition
in which, when you are sleeping for a host of reasons,
you get you go apnik. Ethnic means you stop breathing.
(24:07):
What does that mean?
Speaker 1 (24:08):
You're sleeping.
Speaker 2 (24:10):
And you stop breathing, But that's irrelevant. When you're having
general anesthesia, we're breathing for you. As a matter of fact,
it's the safest responds for sleep apnea. So sleep apnea
doesn't have anything to do with general anesthesia. Now, some individuals,
as a result of chronic, really bad sleep apnea, get hypertension,
(24:32):
they have a may pretension, they have.
Speaker 1 (24:34):
All these other conditions.
Speaker 3 (24:36):
And we definitely will watch those patients a little bit
more carefully than we even though we normally do throughout
and also post off sure, but it's not a reason
to not have surgery once you've gotten your pulmonary claim right.
Speaker 2 (24:51):
So what happens is you have a condition in this
instance is sleep apnea.
Speaker 1 (24:55):
In this condition, it's diabetes. In this condition, it's hypertension.
Speaker 2 (25:00):
We require your doctor manages that condition to say that
your condition not went away, but it's managed, it's under control.
Which case, when you're under Jennic Teacher, you're behaving the
same you were before you were.
Speaker 1 (25:14):
Under any teacher, you are stable.
Speaker 2 (25:16):
So sleep apnea, stable sleep apnea, well controlled sleep apnea,
in our estimation, is absolutely not a contraindication to having surgery.
We believe you will do just fine, assuming your doctor
is good, your post top care and recovery is good.
As a matter of fact, my producer Maria, who had
recently had a breast explantation, reduction, etc.
Speaker 1 (25:40):
She had sleep apnea, was.
Speaker 3 (25:41):
Honesty path it's not uncommon and.
Speaker 2 (25:45):
Was actually very concerned naturally and she a breeze. As
a matter of factur of sleep apne is better.
Speaker 1 (25:51):
But that's neither here nor there.
Speaker 2 (25:52):
Okay, jed underscore Dilz dills. What are the possible side
effects of Jenna? What are the risks of dying from
Generis seizure? So those are two separate questions. Let's address the.
Speaker 1 (26:04):
One that's easy, the risk of dying from general anesthesia.
Speaker 2 (26:07):
We don't know the exact statistic, but it's point zero
one million percent. In other words, it's super rare. You
are more likely to get run over by a drunk
driver statistically than die in general under general a estesia.
Caveat with a legit anesthesia provider in a legit environment
(26:28):
where you are healthy individuals. So let me rephrase that
you were healthy. You didn't walk into general anesthesia with
a high blood pressure of one ninety two.
Speaker 3 (26:37):
Or even if you're not one hundred percent and healthy.
But everything that can be disclosed was disclosed, right you
or someone in your family said hey, they have this, this, this, this, this,
and this. I'll alter what I'm going to do and
we'll keep you safe. Your risk is a little bit higher,
but it's still not oh you're gonna.
Speaker 1 (26:55):
Well well noted.
Speaker 2 (26:56):
One of the amazing parts that you guys don't understand
about any diesia is they go into manual mode.
Speaker 1 (27:03):
Let me explain this to you.
Speaker 2 (27:04):
When you get a DSLR camera, ninety nine point nine
percent of people put on auto and they shoot photos
and the camera is deciding your aperture, your shutter speed,
all these things because we don't know what we're doing.
When you get anesthesia, they took it on manual. The
anisesiologists regulates your blood pressure, regulates your heart, regulates your oxygenations,
(27:24):
opens up your lungs, puts in stuff that dilates things.
They literally micromanage everything about it is. So if you
end up coming in and you got into a car accident,
they don't have time to get you cleared. They take
care of you and you would do fine. So you
dying from general anesthesia is one of those urban legends.
Those are fears that people have, just like people are
(27:47):
afraid of dogs, people are afraid of flyind.
Speaker 1 (27:50):
They're not rooted in reality.
Speaker 2 (27:52):
Bugs, bugs you have in insects.
Speaker 1 (27:55):
So you will be fine, absolutely fine.
Speaker 2 (28:00):
Obviously don't go to some strip mall in the middle
of like Miami, you know, you know whatever, but generally speaking,
not a concern. Now, the other question, which was more
apropos what are the side effects of general anesthesia?
Speaker 3 (28:14):
So two of the main side effects, if left unchecked,
are like shivering and nausea, So those are two of
the main set ort.
Speaker 1 (28:25):
Term, right, short term.
Speaker 2 (28:26):
So what it is is, so let's just talk about
reactions and side effects.
Speaker 3 (28:31):
Oh and sleepiness once again short term. But you know,
after the fact, you're like, oh, we feel groggy, how
do you feel? I feel okay, I'm sleepy, I'm tired.
Speaker 2 (28:40):
So I'd like to qualify that that's a distinction between
reaction and side effect. The reaction is I had general
anesthesia and for twelve to forty eight hours, I am nauseous.
That's not a side effect. That's a reaction to the medications.
I am groggy. That's a reaction to the medications. And
(29:03):
immediately in recovery, which you won't ever remember, you might
have a little shiping.
Speaker 1 (29:07):
That's something that you won't even know.
Speaker 2 (29:09):
On the flip side, I can tell you two things
that I know of that is associated with anesthesia.
Speaker 1 (29:15):
Now these are actual side effects.
Speaker 3 (29:17):
None.
Speaker 2 (29:17):
I had my general anesthesia, and here are some things. One,
you may your period, your menstruation may be altered.
Speaker 3 (29:25):
Correct.
Speaker 2 (29:25):
So there are many many women who undergo general anesthesia
for a number of reasons and then they find out
that they missed their mental cycle, or it came early
and then it didn't come for four months.
Speaker 1 (29:35):
It throws off your story.
Speaker 3 (29:37):
And that's from the anesthesia and the surgery together. Your
body went through the stress of surgery.
Speaker 2 (29:42):
So that is NOD. The other is short term hair loss.
It is not uncommon. Again, this tends to be more
common in women than in men. And I think it's
hormone driven and it's not the actual anesthetic. But I
think it's just the shock of the system that you
lose hair for a period of time, and that hair
will always come back because it's not a long term
(30:05):
side effect. So in general general anesthesia, modern day general
anesthesia is phenomenal. It is really a truly remarkable component
of medicine that without which we would literally be doing
no robotic surgery, no spines discs, no into cranial electrode placement, no, no, no,
(30:28):
no nothing. It is the gateway to all of the
incredible face transplant. Right, All these things occur through general asteesia.
Speaker 1 (30:37):
All right, h.
Speaker 2 (30:42):
Bibblurd is it possible to wake up in the middle surgery?
Speaker 1 (30:46):
I love these questions.
Speaker 2 (30:47):
You guys ask great questions because on our last episode,
which was several years ago, we addressed these individual things
just because we knew people would be concerned. But I
like that you guys are asking it so again another
one of these. The reason why this show is so
relevant and why we do it we try to do
it often, is because these anesthesia is that thing we're
(31:07):
scared of, and it's almost ninety percent of it is
urban legend or or I.
Speaker 3 (31:12):
Heard or my friend told me so that her cousin.
Speaker 2 (31:17):
Right, that her cousin's gardner knew a guy in Guatemala.
So so there they're I'm gonna break this into two parts.
One is can you wake up during general anesthesia? And
the other I'm going to add is be awake and paralyzed.
Those are the two things that people are afraid of,
So let's address that.
Speaker 3 (31:35):
So I have never personally had a patient who has
had awareness during the anesthesia. But I have had patients
who've told us or told someone else that, like you said,
either they or their mom or their cousin or a
friend was awake during anesthesia, you know, at some point,
(31:58):
and it's they're not trying to get anything out of it.
I don't know whether it was true or not. You know,
I don't know if they're remembering something from a different
period mechanism.
Speaker 2 (32:09):
So take me through the mechanism of how a person
can be so it could be away.
Speaker 1 (32:13):
So as far as awake is very simple.
Speaker 2 (32:17):
You're not you're you're you're you're not deep enough the
way you're awake. Next thing you know, you're under generostesia.
There's levels of depression. So awake, totally awake, stop breathing.
You died, right, there's this, this, this's, this, this thing here,
And as the doctor gives you more anesthetic gases, injections, medications, narcotics,
(32:38):
your consciousness, your physiology is shutting down, your heart is
slowing down, your mental capacity is slowing down, and your
lung stop breathing.
Speaker 1 (32:47):
The whole purpose of generosteesia is to get you low.
Let's say this is the floor. You're up here. I mean,
you're miles away from.
Speaker 2 (32:54):
Being deceased, but they try and keep you close to
the surface so that you're safe. Now, it's possible that
during anesthesia, you're anesthesiologist runs you a little light. Remember,
their objective is to keep you not super low, but
low enough where they can do the surgery safely and
bring you back out.
Speaker 3 (33:13):
And it can also happen to where the anesthesia provider
is administering the correct amount and something is blocked to
where it wasn't getting through or something right.
Speaker 2 (33:23):
So that's a very good comment. Let's say there, remember
how do we get all the drugs in you? Aside
from breathing them. Some of them are intravenious. Let's say
your elbow is bent and you know they're giving you
the drugs and for a very short period of time.
But this idea that you're awake, you don't go from
geno anesthesia and then you're like, oh my god, you
should see people in recover. It takes thirty minutes to
(33:44):
come to even after they shut everything off. So what
is possible is that you get a little light and
during surgery patients will start moving or bucking. They have
no recollection of it. And then the anthesiologists who's there,
they're not down the stree, who's there, goes, oh, okay,
this patient is metabolizing more than I had anticipated.
Speaker 1 (34:05):
There they work out.
Speaker 2 (34:07):
They have a gene that eats through it more and
they just churn up the dose. But it really is very,
very very unlikely that you'll just wake up from antices. Now,
talk to me about this awake but paralyzed component, because
this is like the biggest fear of all patients in
the world. And every so often you watch one of
these Late nine shows and a guy's like, I was
awake and they were hammering my femur and I couldn't
(34:29):
tell them anything, and everyone's like never having at a
CJ again.
Speaker 3 (34:33):
But I'm glad that she said hammering their famer because
I have heard of that, and it might be some
of those circumstances might be someone who's having say a
C section, so they got a spinal or an epidural
and so they can't feel it, thank goodness. But up
here they were given something, but now it kind of
(34:54):
wore off near a little bit awake or for me,
replacement or a hip replacement or a foot surgery to
where they get, you know, temporarily intentionally paralyzed and numbed
on their lower extremity and then a little medication up
here to be sedated, and then it may have worn off.
Speaker 2 (35:14):
So so let's chat about that, because I think that
is exactly what happens. So we talked about local conscious
sedation generlineicesia. We left out spinals, right, epidurals and spinals
and what that is, and nerve blocks and nerve blocks,
which that means is that you're at a caesiologist takes local,
the local you put here around your eye or your
(35:34):
lip or whatever, and takes local and sticks it in
the spinal canal and numbs everything below that level down.
So a very common one is an epidural form se
sex section. It's like the standard way of doing things
they don't want to knock you out. You are awake,
but you feel nothing from the you know, rib cage down. Okay,
(35:57):
but it is very common, not in a sea section,
but for other cases like orthopedias where they are traumatic,
right that they give you drugs that sedate you. So
you're conscious sedation on the top of your body and
you are nerve blocked or spinal epidural on the lower
part of your body. And what happens is that you
(36:18):
kind of lighten up and that you wake up and
you're like, oh my god, I'm paralyzed. Yeah, you're paralyzed.
That was the procedure, and I'm awake. So that all
being said, the total number of such cases is minor,
if at all. Ever, so I certainly would not go
get my whatever fix because I'm afraid of it. I
(36:40):
think that leaves us with the last question. And look
at that where somebody put this thing together and it's brilliant.
Speaker 1 (36:48):
So it says.
Speaker 2 (36:52):
Mamo office, Mama five corrected. Can tell me to speaker
formed with an epidural and sedation versus going under general anesthesia.
So that was like, it couldn't have been a better
like lag, So can you do an epidural based tummy chuck.
Speaker 3 (37:13):
Let's let's say we were in a different setting or
something like that. Could it be done? I would say
it could be done.
Speaker 1 (37:21):
You can't paralyze the muscle.
Speaker 3 (37:22):
Hm hmm. Well, well are they having the dr repair?
Speaker 2 (37:28):
Well, I mean just elevating the muscle flap, just elevating
the flap with this.
Speaker 1 (37:32):
This is right right?
Speaker 3 (37:34):
I see. So there you have it. What was the
name that can't?
Speaker 2 (37:38):
Yeah, mumma five, let me explain you.
Speaker 1 (37:41):
Yes and no? Okay, yes, your anes caesiologists can.
Speaker 2 (37:45):
Put Can you explain any difference between a spinal and
an epidural?
Speaker 1 (37:50):
Real quick?
Speaker 3 (37:50):
Spinal goes in, we're putting the It goes.
Speaker 2 (37:53):
In into the canal, and the epidural is on the
outside of.
Speaker 3 (37:57):
It, the outside. So one is past the dura. Well, yes,
past the dura and one is outside.
Speaker 2 (38:05):
Of Okay, how does that? What difference does that make
in terms of the anesthetic? Is one shorter, one longer?
Does one goes some?
Speaker 3 (38:11):
One?
Speaker 1 (38:11):
One is?
Speaker 3 (38:12):
One is one. If you're giving us the spinally, you're
giving a much smaller dose and it's going to come on,
but it's gonna what's going to wear off? Usually depending
on which exactly local anesthetic you use more quickly. One
is designed usually to where you can place a catheter
for the epidural, and it's much larger amounts and dosing,
(38:36):
and it can.
Speaker 2 (38:36):
So you use a spinal for a shortcase and use
an epidural for a longer case.
Speaker 1 (38:40):
Is that is that how you choose?
Speaker 3 (38:42):
That's one that's one way to Yeah.
Speaker 2 (38:44):
So, and let's just say it's an epidural for the
tummy chuck. If we were we wouldn't do it with
a spinal wear off. It's a three hour kise, so
we put an epidural. And yes, you're a cesiologies can
make it so that you are awake and you feel
nothing from your rip cage down right, because your concern
is anything lower than your diaphragm, right, that's the area.
(39:05):
So you cannot have this chart out right because you
do it baby delivery and they don't feel anything.
Speaker 1 (39:09):
They're abdoment.
Speaker 2 (39:09):
So yes, the problem you're going to run into is
that in order to do in a tummy tuck, my
tummy tucks, I need the muscles paralyzed because when I'm
opening the abdomen with my cattery, the muscles are twitching,
and I need the doctor Houston to give the muscle
(39:30):
relaxing so that there's no twitching of the muscle. The
minute she gives you muscle relaxes, you stop breathing because
she's knocking out all the muscles, and that includes your
breathing muscles. Yeah, I can't open without muscle paralysis. And
I can't repair your separated muscles your diastasis, which is
(39:50):
ninety percent of tummy tucks. So yes, you couldn't have it.
I know there's doctors could do breast dogs, but it's
the same issue with it because I need aalysis of
the muscles. So I don't think it's a very effective way.
And the only reason people are asking is because they're
afraid of general ansty right, right, They're afraid.
Speaker 1 (40:08):
Of like, Okay, how do I avoid this horrible thing? Well,
that's it, ladies and gentlemen. You guys have done an
excellent job.
Speaker 2 (40:15):
We thought we try this approach to anesthesia dialogue as
opposed to our last approach.
Speaker 1 (40:21):
Which was just sort of a boom boom boom list.
Speaker 2 (40:23):
I kind of liked it because you guys did a
good job and I asked some good questions all right.
Any parting advice for those people listening at home who
are just dying to go get some surgery.
Speaker 1 (40:34):
Done in there freaking out about anesthesia.
Speaker 3 (40:36):
Yeah, just continue to do your homework from reliable sources,
from reputable sources, not just like some random source.
Speaker 2 (40:48):
So TikTok is that reliable or right?
Speaker 3 (40:52):
So and then yeah, you can look at the American
Society of Anesthesiology websites or something like that and get
reliable informing.
Speaker 2 (41:01):
Yeah. I think the reality is that the same amount
of emphasis and energy you placed at selecting your surgeon
that's sort of oh my god, this guy's gonna cut
me open or this woman is going to you should
be really inquiring about the person putting you to sleep,
because they are the co captain of this experience.
Speaker 1 (41:18):
And all too often patients go in and they just
sign over to the doctor and then they just assume
that the rest of the team is going to be great,
and it just isn't the case. And the question is
why not? And the answer is money, Because the other
members of the team are additional costs, and so if
(41:40):
the doctor wants to be greedy and it is in
their best interest to keep as much money as possible,
they will hire perhaps maybe less effective, less qualified, more affordable.
Speaker 3 (41:54):
Or like you said, to where there might be a
very you know, perfectly acceptable antesesia provider, but they just
never even work with that person before at that place, right,
so they don't know where everything is, or it's a
little uncomfortable, or the dynamic is like, oh.
Speaker 2 (42:11):
I really think the fact that we work together three
times a week, the dynamics and the smoothness, it's so
well orchestrated that when we're in the operating room, god forbid,
God forbids.
Speaker 1 (42:23):
Something were to go wrong, the.
Speaker 2 (42:26):
Speed in which we can address it is going to
be far greater than if it's your first time in
a new environment. You've never been at this facility, you
and the doctor have never interacted before. I do think
that creates a huge issue. Nevertheless, the most important thing
is anesthesia is safe. That is the key thing for
you to take home. All right, guys, Well, thank you
so much for coming. I very much appreciate it.
Speaker 1 (42:47):
I'm sure the patients will love this episode. As always.
Speaker 2 (42:49):
Two things on as I'd like to impart before we
get off. One, if you like to show go right
something nice. People like to hear nice things. If you
have nothing nice to say, I don't write anything.
Speaker 1 (43:01):
And then the.
Speaker 2 (43:02):
Second thing is if you love someone and you think
that they might want to do esthetic surgery or they're
planning on having surgery, then as always share this show
with them because you'll never know till it's too late
that they had something done, and you're like, God, if
I had only known. So as always, I'm your host,
Doctor Roddy Rohnds signing off until next week on plastic
(43:22):
Surgery Uncensored
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