Anesthetic Questions

Q: What is the difference between the types of anesthetic that are used?

A: There are three types of anesthesia that can be offered for most procedures. (Note-there are some procedures that Dr. Miller only offers under general anesthesia).

General Anesthesia

Conscious Sedation

Local Anesthetic

Tumescent Anesthesia

General Anesthesia

What is General Anesthesia?
General anesthesia is the state produced when a patient receives medications for memory loss, pain control, muscle paralysis, and relaxation. An anesthetized patient can be thought of as being in a controlled, reversible state of unconsciousness. General anesthesia enables a patient to tolerate surgical procedures that would otherwise be too painful.

Is general anesthesia safe?
If general anesthesia is performed by licensed anesthetic providers in accredited facilities, general anesthesia is very safe. There are inherent risks with general anesthesia which are thoroughly discussed with each patient during their consultation as well as preoperatively with the anesthesiologist.

How does general anesthesia differ from conscious sedation?
General anesthesia requires the use of a breathing tube that is placed into the airway to ensure that the airway is secure and allows the patient to be hooked up to a ventilator that will breathe for the patient as needed.

When is general anesthesia administered?
General anesthesia is administered for surgical cases that typically cannot be tolerated under lighter forms of sedation. Surgeon preference also plays a role in determining whether or not to use general anesthesia as some surgeons feel a greater sense of control with the patient under general anesthesia. All cases done by Dr. Miller can be done under general anesthesia. However, most cases do not require this level of anesthesia. Cases requiring general anesthesia include:

Who administers general anesthesia?
General anesthesia can be administered by anesthesiologists who are medical doctors or by certified registered nurse anesthetists under the supervision of an anesthesiologist. Dr. Miller uses board certified anesthesiologists for his cases.

Where are procedures under general anesthesia performed?
Surgeries requiring general anesthesia are performed at fully accredited ambulatory surgery centers or hospitals.

What are the side effects of general anesthesia?
With modern advances in medications, monitoring technology, and safety systems, as well as highly educated anesthesia providers, the risk caused by anesthesia to a patient undergoing routine surgery is very small.

The most common side effects include:

Vomiting 10%-20%
Nausea 10%-40%
Sore throat
Incisional pain 30

What Should Patients Expect Immediately Following the Surgical or Diagnostic Procedure?
A qualified provider monitors the patient immediately following the procedure. Written postoperative care instructions should be given to the patient to take home. Patients are typically monitored for 30 minutes to an hour or however long it takes to ensure that the patient has normal and stable vital signs and is appropriate for discharge home or to a previously designated facility. Patients should not drive a vehicle, operate dangerous equipment or make any important decisions for at least 24 hours after receiving general anesthesia. A follow-up phone call is usually made by the healthcare provider to check on the patient's condition and answer any remaining questions.

Conscious Sedation (Twilight)

What is Conscious Sedation?
This type of sedation induces an altered state of consciousness that minimizes pain and discomfort through the use of pain relievers and sedatives. Patients, who receive conscious sedation usually are able to speak and respond to verbal cues throughout the procedure, communicating any discomfort they experience to the provider. A brief period of amnesia may erase any memory of the procedure.

When is Conscious Sedation Administered?
Conscious sedation is administered in hospitals, outpatient facilities, e.g. ambulatory surgery centers, doctors offices, etc., to facilitate procedures such as the following:

Who Can Administer Conscious Sedation?
Conscious sedation is extremely safe when administered by qualified providers. Board certified anesthesiologists, Certified Registered Nurse Anesthetists (CRNAs), other physicians, dentists, and oral surgeons are qualified providers of conscious sedation.

Who Should Monitor Conscious Sedation?
Because patients can slip into a deep sleep, proper monitoring of conscious sedation is necessary. Healthcare providers monitor patient heart rate, blood pressure, breathing, oxygen level and alertness throughout and after the procedure. The provider who monitors the patient receiving conscious sedation should have no other responsibilities during the procedure and should remain with the patient at all times during the procedure.

What are the Side Effects of Conscious Sedation?
A brief period of amnesia after the procedure may follow the administration of conscious sedation. Occasional side effects may include headache, hangover, nausea and vomiting or unpleasant memories of the surgical experience.

What Should Patients Expect Immediately Following the Surgical or Diagnostic Procedure?
A qualified provider monitors the patient immediately following the procedure. Written postoperative care instructions should be given to the patient to take home. Patients should not drive a vehicle, operate dangerous equipment or make any important decisions for at least 24 hours after receiving conscious sedation. A follow-up phone call usually is made by the healthcare provider to check on the patient's condition and answer any remaining questions.

Questions to Ask About Conscious Sedation
The following is a list of questions patients should ask prior to the surgical or diagnostic procedure:

Will a trained and skilled provider be dedicated to monitoring me during conscious sedation?
Yes, we only use licensed, board certified anesthesiologists at accredited facilities.

Will my provider monitor my breathing, heart rate and blood pressure?
Yes, we only use reliable, comprehensive monitors.

Will oxygen be available and will the oxygen content of my blood be monitored?
Yes, we have oxygen available and are constantly monitoring your oxygen levels.

Are personnel trained to perform advanced cardiac life support?
Yes, Dr. Miller is ACLS certified as well as our board certified anesthesiologist.

Is emergency resuscitation equipment available on-site and immediately accessible in the event of an emergency?
Yes, we are completely prepared with onsite resuscitation equipment in the rare circumstance that it is required.

Will a trained and skilled provider stay with me during my recovery period and for how long?
Yes, the patient will be monitored for between 30 minutes and one hour or until the patient is stable for discharge. The patient will be monitored by our anesthesiologist.

Should a friend or family member take me home?
Yes, the patient will need a ride home. If they are unable to find a ride home we have several transportation options available for them.

Conscious sedation provides a safe and effective option for patients undergoing minor surgeries or diagnostic procedures. The number and type of procedures that can be performed using conscious sedation have increased significantly as a result of new technology and state of the art drugs.

Conscious sedation allows patients to recover quickly and resume normal daily activities in a short period of time.

Local Anesthetic

What is local anesthetic?
Local anesthetic is an anesthetic technique that renders a certain part of the body numb without affecting the consciousness of the patient. It allows the patient to undergo a procedure with reduced pain and distress. Patients who undergo a procedure under local anesthetic are completely awake and responsive. In contrast to general anesthesia, which provides memory loss, analgesia, muscle paralysis, and relaxation, local anesthetic only provides analgesia (pain relief).

When is local anesthetic used?

Advances in minimally invasive surgical techniques have allowed for the more widespread use of local anesthetic. Many procedures can now be performed with the use of local anesthetic. These include:

What medication is used in the local anesthetic technique?
Lidocaine is the most common local anesthetic agent. Many people are familiar with this medication from their experience at the dentist. It works by blocking sodium channels in the neurons that conduct sensation and creates numbness in the areas where it is infiltrated.

How long does lidocaine last?
Lidocaine typically is effective for 3-4 hours.

Is Lidocaine safe?
Yes. If used properly in experienced hands. The main risk with lidocaine use is toxicity which results from using too much. Dr. Miller has a lot of experience using lidocaine and always stays within the safe dosage limits.

Is Lidocaine combined with any other medications for a procedure under local anesthetic?
Yes. We typically will give an oral sedative medication such as Ativan which will help the patient relax and create a more comfortable environment for the procedure.

What are the side effects of local anesthetic?
The side effects of local anesthetic are typically much less than general anesthetic. One of the advantages of local anesthetic is expedited recovery time. Although recovery is usually much simpler with local anesthetic, some patients still experience nausea or vomiting in the post-operative period.

Am I a candidate for local anesthesia?
This is a very important question. One of the most important factors to evaluate when considering cosmetic surgery beyond results is the experience. Many people tolerate procedures under local anesthesia very well. Some people struggle and are uncomfortable throughout the process. Chronic back or neck pain, anxiety or panic disorders, and restless leg syndrome are examples of conditions that may make a procedure under local anesthetic an uncomfortable experience. Dr. Miller does a thorough screening evaluation to determine if you are a good candidate.

Tumescent Anesthesia

What is tumescent anesthesia?
The tumescent technique for local anesthesia involves the injection of large volumes of very dilute lidocaine (local anesthetic) and epinephrine (drug that shrinks capillaries) into subcutaneous fat. The word tumescent means swollen and firm. With the tumescent technique, the volume of dilute lidocaine that is injected into fat is so large that the targeted areas literally become tumescent (swollen and firm). The tumescent technique produces profound and long-lasting local anesthesia of the skin and subcutaneous fat. Tumescent liposuction designates a form of liposuction that uses tumescent local anesthesia.

What are the benefits of tumescent anesthesia when doing liposuction?
Local anesthesia used in the tumescent technique for liposuction is so effective that patients no longer need intravenous sedatives, narcotic analgesics, or general anesthesia. As a result of the widespread capillary constriction caused by the epinephrine in the anesthetic solution, there is minimal bleeding during and after surgery. This is a major improvement in the liposuction technique compared to the older methods that simply use general anesthesia.

How does tumescent anesthesia affect blood loss during liposuction?
The tumescent technique is so effective at minimizing blood loss that the majority of patients lose approximately 15 to 30 ml (1 to 2 tablespoons) of blood during large volume liposuction. This is the same volume of blood that is taken for routine pre-operative laboratory studies. In the days before the advent of the tumescent technique, the biggest risk of liposuction was excessive loss of blood during surgery. In fact, many surgeons required their patients to donate their own blood several weeks before surgery, and then during surgery, the blood would be returned to the patient by transfusion. With the advent of the tumescent technique, blood transfusions are no longer a part of liposuction surgery.

How does tumescent anesthesia reduce bruising after liposuction?
There is dramatically less bruising with tumescent liposuction totally by local anesthesia compared to other liposuction techniques under general anesthesia. There are two reasons for this significant decrease in bruising. First, because there is so little blood loss with the tumescent technique, there is almost no blood that remains beneath the skin to cause bruising after surgery. The second reason for decreased bruising is that with the tumescent technique there is a considerable amount of post-operative drainage of the blood tinged anesthetic solution. The incisions are so small (about 1.5 mm) that the incisions do not require stitches. By allowing these wounds to remain open for two to three days after the surgery, most of the residual blood-tinged anesthetic solution drains out. This minimizes bruising and swelling and accelerates the rate of healing.

How safe is tumescent anesthesia when used in liposuction?
There have been no reported deaths associated with tumescent liposuction totally by local anesthesia. Virtually all deaths associated with liposuction have been associated with

  • Multiple unrelated surgical procedures performed on the same day (facelift, breast augmentation, hysterectomy, etc),
  • Excessive amounts of liposuction or an excessive number of body areas treated by liposuction on a single day
  • The use of general anesthesia or heavy IV sedation with narcotics.

Liposuction is an extremely safe procedure provided the patient is not exposed to excessive surgical trauma, excessive narcotic analgesics, or prolonged use of general anesthesia.

Meet Dr. Miller

Meet Our Surgeon - Dr. Todd Miller

What draws Dr. Miller specifically to Facial Plastic Surgery is being able to provide patients with a unique skill set involving the head and neck. He has performed a vast number of facial cosmetic procedures. He has authored articles for national publications and made numerous presentations at national and regional meetings. He is a board certified member of the American Academy of Otolaryngology/Head and Neck Surgery. More...

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