By Dr. Scott W. Mosser

The Ouch Factor

At some point in almost every consultation with a patient or prospective candidate for surgery, I hear the questions, “Will it hurt?”, “Will I be awake or asleep?”, or, “How much will I feel?  All are excellent questions and all worthy of specific and detailed answers. 

This is Not the Anesthesia of 20 Years Ago

In our modern age of medical enlightenment, every surgical procedure uses some form of anesthesia to relieve discomfort and dull the senses of pain.  Technical advances in equipment, improved monitoring, new and better drugs, and specialized training, have all played their rolls in making anesthesia not only more comfortable, but much safer than in the past.

Many surgical procedures that once could only be performed in a hospital because of the after effects of the anesthesia used - and not because of the surgery itself - now routinely take place outside of a hospital.  It is estimated that almost half of all surgeries performed are now done on an outpatient basis, either in a hospital, an ambulatory surgical facility, medical clinic, or doctor’s office.

Newer and safer anesthetic drugs allow more precise control of consciousness and result in fewer side effects, both during and following surgery.  Anesthetic drugs that quickly disappear from the bloodstream allow patients to go home within hours of many surgical procedures.

Deaths due to anesthesia in generally healthy patients have dramatically declined in the last twenty years, from 1 in 10,000 cases to an estimated 1 in 250,000 cases, according to the American Society of Anesthesiologists.

The (Painful) Old Ways: ‘Ancient’ History Of Anesthesia

Until the advent of effective anesthesia, elective surgery was rarely performed.  Undergoing surgery for serious health reasons, accidents, or injury was excruciatingly painful, so very few people opted for surgery unless they had no choice. 

Throughout history, doctors used various techniques to dull sensation for surgery.     Some doctors used soporifics - sleep-inducing and awareness-dulling agents - and narcotics.  Many traditional natural plants were used in the preparation of pain-killing drugs, including marijuana, belladonna, and jimsonweed.

Distraction was another approach.  Healers would be brought into the operating theater to attempt to induce a psychological state of anesthesia in the patient by mesmerism or hypnosis.  Rubbing the patient with stinging nettles was another more unusual distraction used.   Many other drugs were tried, including heroin and cocaine, most with distressing side effects, with opium and alcohol eventually becoming the most common.

Until the mid 1800s the anesthesia drugs of choice continued to be opium and alcohol.  Unfortunately, both were difficult to administer and unpredictable; the large doses of alcohol needed to produce stupefaction caused nausea, vomiting and even occasionally death, instead of sleep. Opium, a strong analgesic, had significant side effects also and typically was not powerful enough to completely blunt the pain of surgery.

In 1846, only one hundred and sixty years ago, William T.G. Morton, a Boston dentist, demonstrated the use of ether on a patient undergoing surgery for removal of a jaw tumor.  It was considered a defining moment in the history of surgery.

Anesthesiology Becomes Recognized in its Early Development

As great leaps forward in surgical techniques greatly increased the number and sophistication of both mandatory and elective operations being performed, the anesthesia considerations became the most life-threatening part of most operations.

More focus was put on development in the 1970s and 1980s as the cost of malpractice insurance for anesthesiologists in the US soared.  In this critical period of change, the malpractice crisis galvanized the profession to address serious issues of patient safety.  In short, the national anesthesia organizations responded by recommending an extremely intense degree of monitoring for all patients.  This simple change led to an enormous increase in anesthesia safety, and it’s fair to say that this, more than any other factor, led to the extremely safe anesthesia we now utilize.

At the same time, scientific experimentation resulted in safer and more effective drugs to replace ether.  The surgeons themselves developed new machines and instruments for controlled delivery of the drug, and specialized training brought new regulations and standards into anesthesiology.  The use of anesthesia simulators enabled anesthesiologists to gain experience in a computer-controlled environment without endangering patients.

Anesthesia Procedures

For a majority of plastic surgery procedures a general anesthesia is not required, and usually does not necessitate a hospital stay.  In many cases, the patient has a choice regarding the type of anesthesia to be used.

General anesthesia puts the patient into a sleeplike state for the duration of the procedure and careful monitoring is required.  Regional anesthesia is used to numb a specific region of the body while the patient may be awake during the procedure, but feel nothing.  A common example is the epidermal often used in childbirth. Local anesthesia numbs only the specific body part being operated on, and the patient is completely awake or under gentle sedation. 

Information and Communication = Safety and Peace of Mind

Anyone contemplating surgery requiring anesthesia should understand that there is always some degree of risk involved.  But most people’s fear of anesthesia dates back to a time just 20 years ago, before the dramatic improvements.  It’s best for patients to try to realize that a blanket fear of anesthesia in this day and age is unrealistic and unproductive.  A patient is best to direct his or her energies toward understanding the anesthesia plan and asking questions to understand the overall experience.

The anesthesia to be used in whatever surgical procedure you choose should be one of the topics to be thoroughly discussed prior to surgery with your Board-Certified Plastic Surgeon.  He or she needs to know, together with your complete medical history, of any indications of possible allergies or previous reactions to anesthetics you may have experienced. 

This information is critical in determining the anesthesia and surgical procedure that will be safest and most comfortable for you.