Anesthesia

All surgical procedures require some form of anesthesia. Novocaine is a type of anesthesia. The word anesthesia means “the absence of sensation.” Anesthesia can be given in many different ways, and  different surgical procedures have different anesthesia requirements.

Types of Anesthesia

Local anesthesia means putting the area having surgery to sleep – making the skin numb.

There are 2 types of local anesthesia:

  1. Special creams that put the skin partially to sleep, not enough for surgery but useful for minor non-surgical procedures such as laser hair removal, Botox® injections and fillers.
  2. Injections that put an area of skin and other tissues totally to sleep.

Twilight or sedation anesthesia means putting you partially to sleep using intravenous drugs.

General anesthesia means putting you totally to sleep with intravenous drugs and other drugs

Which Type of Anesthesia Is Best?

The type of anesthesia that is right for you and your procedure will depend on the procedure, your age and general health, your medical doctor’s preference, Dr. Gerut’s preference and your preference.

Usually the decision on what kind of anesthesia is best takes little or no time to make as all those involved in making the decision agree easily. Once in a while the decision is not easy. When the decision is more difficult, many believe it is best to let the doctors make the decision. Some patients feel they know best what suits their minds and bodies regarding surgical anesthesia and this may be true. But in many instances the people who have experience with these procedures on a daily basis are best qualified to select anesthesia methods. In addition, most patients want their surgeon to be totally comfortable during their operation. This is more likely to be the case if the surgeon stays with his or her preferred routine, which includes the type of anesthesia he or she uses in that particular procedure. The decision between local anesthesia, twilight anesthesia or general anesthesia is usually difficult for a patient to make alone and again, many patients prefer to let the experts make the decision for them. If you eventually decide to have a surgical procedure, all anesthesia decisions will be discussed with you.

For your information, we will explain many of the different anesthesia options starting with the simplest, which is a cream that numbs the skin.

Anesthesia Creams

Certain creams can numb the skin because they penetrate the skin down to the most superficial nerves. These creams cannot make even minor surgery comfortable, but they can make chemical peels or other resurfacing procedures and small needles such as for Botox®, Restylane® or Juvéderm® injections less painful.

Injections

Local anesthesia is commonly known as Novocaine. Actually there are many different injections that can make you numb. They have names like lidocaine, marcaine, carbocaine, but basically they all do the same thing.

Local anesthesia stops nerves from functioning; both the nerves that let you feel things and the nerves that tell your muscles to move. So, if an area of your face or body is made numb, superficial muscles will not function. That is why your lip doesn’t move after the dentist makes it numb. Local anesthesia is very useful for small procedures within a defined area. Very large procedures cannot easily be done with local anesthesia because there is a limit to how much can be given. Very lengthy procedures may be difficult to do with only local anesthesia because it may be difficult for a wide-awake person to lie still for very long periods of time.

Usually an injection of local anesthesia also contains adrenaline also known as epinephrine or adrenaline. This is used to shrink the blood vessels in the area of surgery, which minimizes the bleeding and therefore minimizes the bruising. Sometimes, the adrenaline affects the pulse or blood pressure, which is why some people get palpitation feelings when they are given local anesthesia. Often this feeling is mistaken for an “allergy to novocaine” or an “allergy to adrenaline”. Please understand that although people can be sensitive to adrenaline, almost no one is allergic to it. Indeed adrenaline is the best treatment for severe allergic reactions. There are people that are allergic to Lidocaine and usually they are aware of this from childhood.

Options other than local anesthesia

If any type of anesthesia other than local is to be used, some amount of medication will be given to induce sleep. Therefore special precautions will be taken. These precautions will vary with the nature of the procedure, your age and general health patient and the preferences of the professionals involved.

If you are to be asleep for a procedure, whether a little sleepy or more, you will be attached to several monitors for your safety. These attachments will be placed before you are asleep. Do not be intimidated by all these devices. None of them are painful, not even unpleasant and they are provided to protect you and ensure your safety.

A blood pressure cuff will be placed on your arm. Your blood pressure will be taken frequently as you sleep. Don’t be afraid when it inflates. It usually gets very tight only the first time it takes your blood pressure. A pulse oximeter to monitor the level of oxygen in your blood will be placed on one of your fingers or toes. This device measures the oxygen level in your blood from moment to moment; this is of course very important for your safety. Three or more sticky EKG pads will be placed on your chest and wires attached to them. These sticky pads monitor the electrical activity of your heart, known as an electrocardiogram. Before you sleep you may also have a large sticky pad placed on your leg or back. This is not a monitor, but is a grounding pad for the electric cautery machine that is often used during surgery to cauterize small blood vessels. Often a temperature monitor is placed which can be a piece of tape on the forehead, other times a probe is used. There are other monitors used with general anesthesia, for example a carbon dioxide detector attached to the breathing tube (if there is one) in your mouth. All these things and more are designed to keep patients safe during anesthesia.

All of these things will be used to keep you safe during a procedure done under twilight or general anesthesia, which are described below.

Sedation / Twilight

There are many types of twilight or sedation and many procedures are done using different levels of sedation combined with local anesthesia. All involve giving you intravenous drugs that make you sleepy and take away pain. One commonly known sedative drug is Valium, but there are many others that are used such as Brevital, Diprivan, Demerol and Versed. Whichever sedative is used, Dr. Gerut will also use local anesthesia so that the numbness from the local anesthesia combined with the sleepiness from the twilight allows you to sleep comfortably through the procedure. There are so many different drugs used for sedation, it is impossible to give a complete list of all options and possibilities. Overall the amount of medicine you are given during sedative or twilight anesthesia depends upon your physiology and body type how asleep you need to be, how significant the procedure is and how long the procedure takes. Almost always, local anesthesia must be used along with sedation to numb the entire surgical area. Therefore the purpose of the sedative is to keep you asleep and unaware of the local anesthesia injections and so that you can stay still in one position comfortably as Dr. Gerut works.

General Anesthesia

When general anesthesia is used, an intravenous is placed. Then there is either a mask placed on your face that allows you to inhale anesthesia gases or a tube is placed into your mouth that delivers oxygen and the anesthesia gases. Usually you are also given intravenous drugs as in sedation, but general anesthesia is different from sedation because general anesthesia uses the breathing tube or mask, which is attached to an oxygen anesthesia machine to deliver oxygen and anesthesia to your lungs. If a tube is used, it will be placed into your mouth and throat well after you are asleep and it is removed before you wake up. You will not feel the tube at all. Sometimes, however, patients can experience a sore throat after general anesthesia. This is probably due to the tube, but it is not known why some people experience the soreness and some do not. Regardless, it is treated with simple throat lozenges and it goes away quickly. For large surgical procedures outside of Plastic Surgery such as blood vessel surgery or intestinal surgery, general anesthesia means that local anesthesia is not used and you are given enough drugs so that you feel absolutely nothing while the doctor works. For aesthetic surgery, even if is performed under general anesthesia, most patients are given local anesthesia and therefore in Plastic Surgery, general anesthesia often involves less drugs and a lighter sleep. This usually translates into less of a hangover from anesthesia and therefore a quicker recovery.

Remember; all the modern technology we described here as well as all the training and expertise of those caring for you are specifically directed toward keeping you safe and providing a good surgical result.

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