Breast Lift Surgery Anesthesia
The transition period both going under and coming out of anesthesia can be frightening, especially if it's your first time. A little knowledge about anesthesia, why it's needed, how it works and what to expect can go a long way towards addressing your concerns and making you more relaxed on surgery day.
Why Do You Need Anesthesia?
The easy answer is "to stop pain", but anesthesia is actually needed for several reasons. In addition to preventing the patient from feeling pain, it also is used to immobilize the patient and to control the body's defense mechanisms that deal with pain.
Although you can tell the difference between a safe, elected incision and an accidental skin trauma like a cut or a stab wound, your body cannot. As soon as it is cut, your body goes to work fighting off the invader. Your heart rate jumps, your blood pressure rises, and your body starts to try to repair the injury with a vengeance. Anesthesia blocks this natural reaction until after the surgery is over and keeps your body from trying to overwork itself during surgery. It also helps you forget about your surgery. Surgery can be very traumatic, so why suffer? Healing is better and faster when you don't realize or remember the pain.
How Does Anesthesia Work?
Anesthesia works in 5 ways:
- as an analgesic (pain reliever)
- as an amnesiac (loss of memory)
- to promote unconsciousness
- to immobilize the patient
- to eliminate or reduce autonomic responses like tachycardia (increased heartbeat), increased breathing, and hypertension (high blood pressure).
The duration and effectiveness of anesthetics are dependent upon your body fat, weight and the strength or concentration of the drug itself. Some patients have a higher level of tolerance than others. All this must be taken into account by the anesthesiologist to safely administer and maintain a pain-free state of unconsciousness.
Your Options In Anesthesia
You may have a few anesthetics to choose from when it comes to your surgery, although not all surgeons and their practices will offer every one. There are several types of anesthesia, some of which are used in breast lift surgery.
The four main categories of anesthesia are:
- Local anesthesia
- Regional anesthesia (nerve blocks)
- Sedation
- General anesthesia
Local Anesthesia
Local anesthetics are what you have when you receive a shot to numb the immediate treatment area, usually only the skin and tissue just below the skin. The drugs most commonly used in local anesthetic shots are lidocaine (one brand name is Xylocaine) or bupivacaine (brand name Marcaine). Different local anesthetics have different rates of absorption, toxicity and duration.
A local is also sometimes used during a rhinoplasty (nose job), or in conjunction with another type of sedation, but it is not used during breast lift surgery.
Regional Anesthesia
As its name implies, regional anesthesia affects just a region of the body without rendering the patient unconscious. It is injected around a major nerve or the spinal cord to block a larger area than local anesthetics can cover.
Regional anesthesia is sometimes called a peripheral nerve block. Epidurals and spinal anesthesia, which are often used during childbirth, are two types of regional anesthesia. Regionals are usually administered with a mild sedative to help the patient relax.
In cosmetic surgery, regional blocks are most often used in facial procedures, including brow lift touch ups, lip reduction and augmentation surgeries, chemical peels, and liposuction under the chin. Regional anesthesia is not used in breast lift surgery.
Conscious Sedation
Usually administered intravenously (IV), conscious sedation makes you relaxed and drowsy. The medications used may include muscle relaxants, paint medications and drugs that cause temporary amnesia. Liquid IV sedation is commonly utilized for breast lift surgery.
The IV line is usually placed into a vein on the inside of the elbow or back of the hand. The procedure is similar to a blood draw and may sting slightly at first. Once the needle is in the vein, it is pulled out and a small plastic tube is left behind in its place. This tube, called a catheter, is taped to the skin to hold it in place. A nurse or staff member than connects a bag of fluid to the IV line, which remains closed with a roller device until the IV is needed. The bag usually contains saline (sterile saltwater). Medications can be added to the saline and dripped into you as needed. The saline keeps you hydrated both during and after surgery.
You'll feel the effects of IV anesthesia very soon after the medications start to flow into you. It may feel like heat entering your veins and flowing up your arm.
Oral sedatives, including Valium (diazepam) or Zanax (alprazolam), may be administered about an hour before a surgical procedure. Their purpose is to help you relax and alleviate anxiety. They also make you calm and drowsy and, depending on the dosage, you may even fall asleep.
General Anesthesia
General anesthesia affects the entire body and is used for more extensive surgical procedures, or when other forms of anesthesia should not be used. A general is administered in liquids via IV, inhaled gases, or both.
There is a greater chance of side effects with general anesthesia than with other forms of anesthesia, but only a small percentage of people have a problem and side effects are usually temporary. While you are unconscious, your vital signs will be monitored.
General anesthesia is sometimes preceded by a sedative or medications that impair your memory. These can be administered either orally or by IV. Consequently, you may be sleepy before you even get to the operating room; after surgery you may not recall being taken into the O.R., even if you were awake at the time.
In the operating room, a mask will be placed over your face and nose and you start to breath in the gas. Once you are unconscious, the anesthesiologist or the anesthetist will remove the mask and insert a tube down your airway to continue administering the gas and to ensure that your airway (lungs and throat) remain open. This is why your throat may be irritated or sore and your throat and mouth may feel dry after surgery.
If you are nervous about undergoing anesthesia (and this is very normal), you can ask your surgeon or the anesthesiologist for an antianxiety drug such as Valium or Xanax that you can take the night before or the morning of surgery. Never take any medication before surgery without your anesthesiologist and surgeon knowing about it.
Why Shouldn't I Eat Before Surgery?
Fasting before anesthesia ensures that no undigested food remains in your stomach that you might throw up. The danger is that you might vomit while on your back and inhale some of the material into your lungs. Anesthesia interferes with your normal reflexes, including the one in your throat and airway that keeps you from choking.
Take your surgeon's instructions about when to stop eating very seriously. You will be told not to eat anything after a certain time the night before your procedure, sometimes as early as 10 p.m., depending on what time your surgery is scheduled. If you must take medication the morning of surgery (with your surgeon's approval), do so with only a few sips of water.
Who Will Administer Anesthesia?
Anesthesia can be administered by an anesthesiologist, a medical doctor trained specifically in anesthesia and pain management. It can also be administered by a nurse-anesthetist, a registered nurse certified in administering anesthetics (identified by the letters CRNA, or Certified Registered Nurse Anesthetist, after their name.) Many hospitals and freestanding surgical units use the latter. In some instances, the surgeon performing the procedure may administer some forms of anesthesia.
Recovery from Anesthesia
Coming out of anesthesia is a highly personal experience that can vary from surgery to surgery. Even if you have tolerated anesthesia well in the past, you may experience something different the next time. You may wake up well or be uncomfortable; re-entry may be abrupt or gradual; you may feel hot or cold or possibly numb. You may be nauseous, or start crying or giggling. You may even be confused and think you haven't gone into surgery yet. When I begin to regain consciousness, I feel very cloudy, like my peripheral vision is gone temporarily. Everything is in a sort of white, blanched hue. I get emotional sometimes and this is very normal.
Some patients may become nauseated. If you're one of them, alert one of the nurses so he or she can give you a few sips of cool water or ice chips to help settle your stomach, and provide you with a receptacle in which to vomit. You probably won't be given anything to eat or drink just yet. Some surgeons may give you an antinausea medication to decrease your chances of vomiting following surgery.
Some patients feel cold and begin shivering as they come out of anesthesia. Let the recovery room nurse know if you need a warm blanket.
Whatever your reaction, you will be monitored by the recovery room staff as you regain consciousness. You may be hooked up to machines that keep track of your breathing and heart rate, and you may find a small device clipped to your finger or earlobe that provides a reading of how much oxygen is in your blood.
If you are going home that day, you will be kept there until you are out of anesthesia, although you may still feel somewhat groggy. The staff will go over all your instructions to make sure you understand what you need to do when you get home and in the days that follow.
You must have a responsible adult available to accompany you home, so make sure you have arranged for one. You will not be allowed to drive yourself home. Your surgeon may insist that someone stay with you overnight as well, and if you haven't made those arrangements your surgery may be canceled before it begins or you'll be kept in the hospital overnight.
Even if you planned to go home, an overnight stay at the hospital or surgery center may also be required if there were any complications with your surgery. These include elevated blood pressure, severe nausea, or bleeding. It's better to be safe than sorry in this type of situation.
Risks, Contraindications, and Side Effects of Anesthesia
Anesthesia is not risk free, although the vast majority of patients have no problems with it. The information presented here is not intended to scare you off from having surgery, but rather to make sure you are making an informed decision.
The best precaution you can take before having anesthesia is to talk to your surgeon and to the person administering anesthesia. Make sure that they both know all about your health and any allergies you have, as well as any problems you have ever had with anesthesia. If other people in your family have had problems with anesthesia, mention that, too. Several health conditions—or the medications you take for them—can change the way your body reacts to anesthesia.
Most serious anesthesia side effects are linked to the circulatory and respiratory system, so let your surgeon and the anesthetist or anesthesiologist know if you have ever had any serious breathing problems, including asthma, chronic bronchitis, or allergies that cause you breathing difficulties. Such conditions do not rule out surgery, but both your surgeon and whoever administers anesthesia should know in advance so that they can take precautions.
If you are a smoker (tobacco or marijuana), your chances of having breathing difficulties during surgery escalate. Smoking also impairs your ability to heal later. If you smoke, you will be told that you should refrain for a period of time before and after your surgery.
Likewise, inform your surgeon and the anesthetist/anesthesiologist if you have ever had any heart-related problems, such as a heart attack, heart failure, high or low blood pressure, a history of clotting problems or embolisms, or irregular heartbeat. Here again, you may have no problems with surgery or anesthesia, but precautions may be necessary.
Medication and Supplement Contraindications for Anesthesia
There are many medications and dietary or herbal supplements that you should not take before or after anesthesia. Make sure that your surgeon and the person administering anesthesia has a complete list of all the medications you take, including vitamin and nutritional supplements and any herbal products that you take regularly. If you smoke marijuana or take any recreational drugs, say so.
If you take antidepressant medications, please advise your surgeon. Some antidepressants are monoamine oxidase inhibitors (also known as MAOI) and they can intensify the effects of the anesthesia even weeks after you've topped taking them. This could be a problem if your doctor is unaware of your medication usage. When informed, he or she can make adjustments for your anesthesia.
