MEDICATIONS: GENERAL ANESTHESIA FOR OFFICE-BASED PLASTIC SURGERY: A SAFE ALTERNATIVE

January 2001 - General anesthesia can be used safely and effectively to perform plastic surgery procedures in the office setting, according to a report in the January 2001 issue of the Plastic and Reconstructive Surgery®, the journal of the American Society of Plastic Surgeons (ASPS).

With trained staff, modern equipment and careful procedures, general anesthesia is often a better choice than more commonly used intravenous sedation, even for relatively complex and lengthy office-based surgeries, write Steven M. Hoefflin, M.D., and colleagues of the University of California at Los Angeles/Santa Monica Medical Center.

The authors describe their 18-year experience with general anesthesia used for plastic surgery procedures performed in an office-based setting. All procedures were done at an accredited outpatient surgery facility, in the presence of a board-certified anesthesiologist, with careful attention to patient safety and comfort before, during and after the operation.

In more than 23,000 procedures, no patient died or experienced any major complications, despite the fact that many of the operations were complex. Operations included facelifts, liposuction procedures, breast enlargements/ reconstructions, and nose reshaping. "Our experience differs from the common perception that general anesthesia is too risky for aesthetic surgery procedures," write Dr. Hoefflin and colleagues.

They attribute their excellent safety record to careful attention to detail. The article outlines their approach, from initial telephone calls several days before the procedure through follow-up calls after surgery. During the procedure, the patient's comfort and well-being are monitored continuously by nurses, anesthesia professionals and the surgeon. The authors compare the anesthetic experience to taking an airplane trip: "There are fears and concerns with both flying and general anesthesia. We think that both are the safest way to travel."

There has been a growing trend toward performing plastic surgery procedures in the office setting. Traditionally, office procedures have been done using intravenous sedatives, often in the absence of an anesthesia professional. However, as office-based procedures grew longer and more complex, Dr. Hoefflin and colleagues found intravenous sedation inadequate to meet the needs of patient comfort and safety.

Dr. Hoefflin suggests that, with careful attention to detail, general anesthesia can provide a safer, more comfortable experience for the patient and plastic surgeon alike. The authors question recent reports suggesting that general anesthesia contributes to complications or even death during liposuction procedures. "[Our results] do support the advantages and efficacy of general anesthesia for plastic surgery procedures, including liposuction, when performed by competent, board-certified anesthesiologists and plastic surgeons in a properly equipped and accredited facility."

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