General anesthesia, combo procedures boost risk

General anesthesia, combo procedures boost risk
By:  Bill Gillette
Source: Cosmetic Surgery Time eNews

Cincinnati — Use of general anesthesia, performance of liposuction under general anesthesia, and combining surgical procedures significantly increase the risk for adverse events (AEs) in office-based surgery, a new review suggests.

A review of mandatory adverse-event reporting, derived from 10-year data from Florida and six-year data from Alabama, “confirms trends that have been previously identified in earlier analyses of this data,” wrote lead author John Starling III, M.D, of the University of Cincinnati’s department of dermatology.

Medscape Today reports that according to the study, which appears in the February issue of Dermatologic Surgery, more than two-thirds of deaths and three-quarters of hospital transfers were associated with cosmetic surgery performed under general anesthesia.

The study is especially critical of liposuction performed under general anesthesia, noting that while liposuction is one of the most common cosmetic procedures, no deaths occurred with local anesthesia. “Liposuction under general anesthesia accounted for 32 percent of cosmetic procedure-related deaths and 22 percent of all cosmetic procedure-related complications,” the researchers wrote.

In the Florida statistics, a total of 309 AEs were reported during office-based surgery, including 46 deaths and 263 reportable complications or transfers to hospital. Cosmetic surgeries performed under general anesthesia accounted for the vast majority of deaths in Florida, with liposuction and abdominoplasty the most frequently reported procedures.

In the Alabama data, 52 AEs were reported, including 49 complications or hospital transfers and three deaths. General anesthesia was implicated in 89 percent of reported incidents, of which 42 percent were cosmetic surgeries. Pulmonary complications, including pulmonary emboli and pulmonary edema, were implicated in many deaths in both states.

The authors noted one limitation in their study, which was that case logs of procedures performed under general and intravenous sedation are required in Florida, but are not in the public domain and so were unavailable for analysis. Also, researchers were unable to obtain data on the total number of liposuction procedures performed in either state, which prevented them from calculating the overall fatality rate.

Why LITE™ Anesthesia at Prasad Cosmetic Surgery

Anesthesia Safety

Leading anesthesiologists like Barry Friedberg, M.D. share our professional opinion that most, if not all cosmetic surgery procedures, can be performed safely under local anesthesia with IV or intravenous sedation. Despite this fact, a large percentage of people undergoing cosmetic surgery are subjected to the risks of general anesthesia.

Based on the work of innovators such as Jeffrey Klein, M.D. (inventor of tumescent anesthesia for safe liposuction) and Barry Friedberg, M.D. (inventor of PK anesthesia), Dr. Prasad modified his local anesthesia techniques and created LITE™ anesthesia. LITE™ anesthesia is an acronym for Local, Intravenous, Tumescent/Twilight with Ease of recovery.

Safe sedation using a brain monitor (BIS) monitor and Dr. Friedberg’s PK anesthesia techniques have been the cornerstone to LITE™ anesthesia. Sedation or “twilight” anesthesia helps people who come to our practice recover quickly and often “not remember” the surgery.

LITE™ anesthesia is used in our practice for procedures such as:

Blepharoplasty (eyelid surgery)
Hair transplant
Breast augmentation
Breast lift
Breast reduction
Tummy tuck
Cosmetic gynecology

Increasing Safety in Anesthesia – Using a Brain Monitor

A special message from Amiya Prasad, M.D.:

I just returned from a conference in Charlotte, North Carolina run by Dr. Barry L. Friedberg. If you’ve been keeping up with the trial of Dr. Conrad Murray, who was the physician who administed Propofol to Michael Jackson, you would recognize Dr. Friedberg as being a vocal advocate for patient safety through proper monitoring. Having met Dr. Friedberg at a Cosmetic Surgery Conference (The Annual meeting of the American Academy of Cosmetic Surgery), I was very impressed by his knowledge in providing anesthesia in a safer way using a brain monitor. During surgery, we routinely monitor the heart rate, blood pressure, oxygen levels in the blood and the EKG (electrocardiogram). Ironically, it’s not been routine to monitor the brain which is the organ that the sedation is working on.  I incorporated the use of a brain monitor (also called a BIS Monitor), to monitor the level of sedation being given to our patients during surgery and have been absolutely delighted. Although this technology has been available for more than 10 years, very few operating facilities use BIS monitors. I’m very fortunate to have met Dr. Friedberg and my patients now benefit from his experience. To encourage people to advocate for themselves when it comes to proper and safe anesthesia during any surgery (not just Cosmetic), Dr. Friedberg created “The Goldilocks Foundation” [] . Essentially it’s important in the modern era of health care for people to advocate for themselves. Dr. Friedberg advises to ask the questions “Do you use a brain monitor when I will be under anesthesia?”.

The practice of medicine requires a lifetime commitment to learning and flexibilty to provide the best care for our patients. Unfortunately, the practice of plastic surgery tends to be inflexible and focused on the use of general anesthesia which in my opinion is more for the surgeon’s convenience rather than the patient’s in many cases. As it has been my focus to perform natural aesthetic procedures which are safe, under local anesthesia with light sedation and with a quicker recovery, Dr. Friedberg’s contribution to my practice through his experience is truly appreciated.