ANESTHESIA AND YOU
(sedation- analgesia in plastic surgery)
Although once called “crepuscular state", we believe that the most appropriate name is “conscious sedation", utilized in recent years to describe the status of semi-consciousness which allows the patient to feel comfortable during certain surgical procedures.
In this section we hope to explain "sedation-analgesia" and we shall describe the different levels of sedation, as well as its purpose. Analgesia is the elimination of pain, and hence, also entails a decrease in anxiety. The technique involves the use of different drugs, without using general anesthesia that causes total loss of consciousness. Sedation-analgesia is usually administered through an intravenous catheter, thus achieving relaxation and minimizing patient’s discomfort. It is frequently combined with local anesthesia administered in the area of surgery. With these techniques, there are usually less adverse effects (nausea, vomiting, dizziness, etc.) and a faster recovery than with general anesthesia.
LEVELS OF SEDATION
Although the effects of sedation are described as "states", they are in fact part of a “continuous sedation” divided in three categories:
1) Minimal sedation or anxiolysis.
2) Moderate sedation.
3) Deep sedation.
With minimal sedation, you will feel relaxed, may be awake, answer questions and follow simple orders.
With moderate sedation, you will be generally asleep, but may be awakened by touch or sound, although you will remember almost nothing.
During deep sedation, you will always be asleep and will not remember anything. You will wake up as soon as the medication is discontinued. Local anesthesia is administered while you are under sedation, and therefore you will feel no discomfort.
MONITORING AND SAFETY
As in any type of surgery, your vital signs, pressure, pulse, cardiac and respiratory rhythm, blood oxygen levels, etc, will be continuously monitored with the appropriate equipment. Remember that your anesthesiologist is a trained physician who has completed a residency program in anesthesiology, has studied for many years, is fully specialized and experienced in the field and is hence prepared to solve any type of problem that might arise .
AFTER SEDATION-ANALGESIA
If you have received minimal sedation, you will be able to go home as soon as the procedure is finished. If you received moderate or deep sedation, you will need to be monitored for one or two hours until the effects of the medication have disappeared. Remember that you will not be allowed to go home by yourself, so that you will have to be accompanied by an adult who can be responsible for you at the time of leaving the clinic. Hence, you must have someone willing to care for you in this circumstance, preferably someone you feel comfortable with.
CONCLUSION
When used correctly, sedation-analgesia is extremely safe and effective and is the anesthetic method of choice in outpatient surgery. Remember that the procedure will be performed by a trained anesthesiologist, and thus you will recover quickly and will be able to return home soon.
REFERENCES
This type of anesthesia is used in most centers that perform outpatient surgery. At our center, we use state of the art anesthetic procedures during plastic surgery and have presented papers on this subject at the last American Congress on the specialty (San Antonio, Texas, 2002).