Anesthesia For Outpatient Surgery

Anesthesia For Outpatient Surgery

Question:

I am planning on having an elective cosmetic plastic surgery procedure next month in my surgeon’s office. My surgeon spent a great deal of time explaining the procedure, but really didn’t tell me anything about my anesthesia options. What is anesthesia and what are my options?

Answer:

Oliver Wendell Holmes coined the term “anesthesia” in the mid-1800's to describe the state of etherisation as the absence of sensation. We know that the state of anesthesia is composed of the elements of hypnosis (sleep) and analgesia (pain relief).

You should know that in an office-based setting, you might receive your anesthesia from the surgeon’s secretary (at the surgeon’s direction), a registered nurse with technical training in anesthesia, or an anesthesiologist (an MD specializing in the medical practice of anesthesia). You should find out who will be administering your anesthesia before undergoing your procedure.

In addition, you should know that office-based anesthesia has given rise to the demand for short-acting, fast emerging anesthesia. You may ask if they will offer this to you. This type of anesthesia helps the patient recover quickly, hopefully pain and nausea-free. One type of anesthesia that has become very popular is “PK.” The “P” stands for propofol and the “K” stands for ketamine. The combination “PK” stands for an anesthesia technique pioneered by Barry Friedberg, MD and is designed to maximize patient safety in the office-based setting.

PK technique creates the illusion of general anesthesia, with the minimal trespass of sedation. Patients neither hear nor feel their surgery yet remain at the lightest level of anesthesia short of being awake. This is important because when you have less anesthesia, your risk for “PONV”--post-operative nausea and vomiting--is tremendously reduced. This is one of the most common side effects of surgery, and one that you can avoid with the PK Technique.

Be sure to balance the advantages, and make sure that the facility where you will have your procedure has the ability to handle common emergencies which may occur during your surgical procedure --i.e. oxygen,Ambu bag, and suction device to clear the airway – these are minimal standards insisted upon by medical liability carriers.

According to the American Society of Anesthesiologists’ publication on guidelines for a safe office anesthesia practice, an anesthesia machine is not necessary when non-triggering anesthesia is used. Non-triggering agents refers to an absence of inhalational agents like isoflurance, desflurance, or sevoflurane. In fact, states like California and Florida led the nation in requiring office certification by AAASF, AAAHC or HCFA agencies. Certification assures that a crash cart and defibrillators are present, as well as polices and procedures to handle the day-to-day activities as well as emergencies.

For more information, check out http://www.doctorfriedberg.com/, or email Dr. Friedberg at doctorfriedberg@doctorfriedberg.com.