Secret: Know the difference between an anesthesiologist and an anesthetist. Only one is a doctor.
An Important Date In Anesthesia History
Last evening, as we were informed by a gentleman who witnessed the operation, an ulcerated tooth was extracted from the mouth of an individual without giving the slightest pain. He was put into a kind of sleep, by inhaling a preparation, the effects of which lasted for about three-quarters of a minute, just long enough to extract a tooth.– from a notice that appeared in the Boston Daily Journal on October 1, 1846*
What you may find surprising however, is the relative importance of the relationship between the type of anesthesia used and who is at the controls. There are three modes of anesthesia your surgeon will consider:
Local anesthesia, in which the patient is fully awake, is appropriate for only the most minor procedures. For example, a surgeon might consider it for mole removal. Local anesthesia for cosmetic surgery is like having Novocaine® at the dentist: you are aware of the procedure but the area is numb; you feel no pain.
Local anesthesia with sedation can be safely used for many common cosmetic procedures. Sedatives, painkillers and tranquilizers are administered intravenously for immediate effect. This procedure is similar to having sodium pentothal or a similar sedative for dental surgery, such as a wisdom tooth extraction. You will be asleep, unaware of the surgery, and not remember or sense any of the procedure. Asurgeon may consider this form of anesthesia for simple rhinoplasty, routine upper and lower eyelid surgery, or cosmetic correction of the ears.
General anesthesia, once reserved for inpatient hospital cases, has become more common in outpatient practices. Indeed, technological and drug advances developed in recent years have made general anesthesia the choice for longer, more intricate cosmetic procedures. High-tech monitoring devices that continuously report on vital signs and associated data, coupled with newer anesthetic drugs, have greatly improved the safety of general anesthesia. These innovations allow even the longest operations (up to seven or eight hours) to present little risk to the patient.
How Safe Is General Anesthesia For Cosmetic Surgery?Very safe. Statistics are available that should comfort you. In a journal article published in January, 2001 the authors reported an eighteen-year study of over 23,000 procedures performed in an office-based, outpatient surgery center managed by doctor anesthesiologists. There were no deaths and no serious complications.
Having visited the reporting practice with its attached modern, properly equipped, accredited surgical facility, I was not surprised at its superb history. This enviable safety record is not unique, but as you will learn in this chapter, it is the product of focus, dedication, diligence and a high degree of specialization.
-DJ
Under general anesthesia you are put into a state of unconsciousness. Your vital signs are constantly monitored. Facelifts, necklifts and combination procedures would be examples of cosmetic surgeries requiring general anesthesia. In most cases, local anesthesia is injected into the operative site after you are asleep to reduce the depth of general anesthesia (for safety) and to reduce bleeding.
So, who is most qualified to administer anesthesia in each of the above scenarios? Who should be in control?
Local anesthesia, without sedatives as in a dental office is a low-risk technique and requires minimal electronic monitoring. This is only suitable for the least invasive procedures, as a scar "touch-up" or mole removal. Administration by the surgeon is appropriate.
Sedation-anesthesia (given intravenously for rapid onset), or general anesthesia, must be administered by an anesthesia specialist, not the surgeon. The surgeon's priority is dealing with the details of performing the procedure. He will be far too preoccupied to also be responsible for the administration of anesthetics. When potent pain medications, tranquilizers and sedatives are introduced into the body, observation, monitoring and management of vital functions is a full-time job.
Two different types of medical specialists are qualified to administer anesthesia: nurse anesthetists and doctor anesthesiologists. Nurse anesthetists officially work at the direction of the surgeon, but in practice, they perform their services independently. Nurse anesthetists are licensed registered nurses, who have pursued additional specialty training in anesthesia the nursing parallel of a physician's residency.
Anesthesiologists are medical doctors who have trained a minimum of three years after medical school in their specialty, defined as "the practice of internal medicine in the operating and recovery rooms." The doctor-anesthesiologist is responsible for control of key internal organ functions, particularly those of the heart and lungs. It is important that you are comfortable with the anesthesia issue. Most likely, your surgeon will have a consistent routine for each procedure performed, including the type of anesthesia employed. Most superspecialist cosmetic surgeons prefer to work with a small cadre of anesthesiologists.
I can't say whether one needs an anesthesiologist. I know when I seek care for my family or myself, I want the best-trained professional that is available. That will always be the anesthesiologist.
-Barry L. Friedberg, MD, Clinical Instructor of Anesthesiology, University of Southern California, Los Angeles
By working together they develop consistent patterns and systems that reduce the chance of error much like a basketball team where each player can anticipate his teammates' moves. Safety levels rise with team consistency. This level of familiarity and stability is more difficult to achieve if a surgeon is teamed with a new anesthesiologist for each operation. You should ask what type of anesthetic the surgeon prefers, whether the administrator of the anesthetic will be an RN (registered nurse) anesthetist or an MD (medical doctor) anesthesiologist, and how well the surgeon knows this individual. Understanding the difference in education and training will help shape your preference. Your choice should be honored.
Understandably, there is some "rivalry" between nurseanesthetists and doctor-anesthesiologists. Another medical turf battle. Read here the words of a doctor-anesthesiologist who, prior to becoming a physician, was a nurse-anesthetist.
While the chance of a problem with anesthesia is miniscule, if a difficulty should arise, it could be catastrophic in the wrong hands. You should seek to reduce that risk to the lowest level possible. Decide whom you prefer to have administer you anesthetic. Make your feelings known, without equivocation to your doctor. It's your body. It's your life.
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1. Nose Surgery or Rhinoplasty
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