Anesthesia

Anesthesia is a serious part of any surgery including tummy tuck. Although there may be several options for anesthesia in an abdominoplasty – such as general anesthesia or light sleep – you may actually have little choice in the matter.

The type of anesthesia used for you may be dictated by how extensive your surgery is, your over-all health, where the surgery will be performed, who will administer the anesthesia, and other factors. You need to discuss the types of anesthesia that can be used during your abdominoplasty in advance with your plastic surgeon and determine what he or she recommends and why.

I am going to discuss the different types of anesthesia here and describe them. Not all of these types of anesthesia may be applicable to your case. You must discuss the whole issue of anesthesia with your surgeon.

Why You Need Anesthesia During Tummy Tuck Surgery
You would think that the purpose of anesthesia is to just to stop pain or to immobilize the patient. Yes, anesthesia does keep you from feeling the pain of the procedure and keeps your body from moving, but is also has to do with control: Control of your body and its defense mechanisms that deal with pain.

You can consciously tell the difference between an incision – an intentional cut to your body done for a reason – and an accidental cut, but your body cannot. As soon as your body is cut or injured in any way, your body reacts to the injury. Your heart rate quickens, your blood pressure goes up, and your body starts to repair the injury with a vengeance. Well, anesthesia blocks these reactions until after the surgery is over. Anesthesia keeps your body from trying to overwork itself during surgery.

Anesthesia also helps you forget about your surgery. You don't remember it and therefore you don't relive it in your mind. Surgery can be very traumatic. Healing is better and faster when you do not realize or remember pain.

Sensory, reflex, mental and motor functions must be stopped temporarily to safely and effectively operate on a patient. Anesthesia works in any of five ways, or put another way, there are five different actions that anesthetics can do:

  • They can be analgesic, in that they block, relieve, or stop pain.
  • They can be amnesiac or amnestic, which means that they block the formation of a memory and keep you from remembering a painful experience.
  • They can cause unconsciousness.
  • They can immobilize you.
  • They can stop or reduce autonomic responses such as increased heartbeat (tachycardia), rapid breathing, and elevated blood pressure (hypertension). (An autonomic response is a body action or reaction that is not in your conscious control.)

For surgery, your anesthesiologist or anesthetist may use a drug or a combination of drugs that perform several of these actions. These factors are what make it possible for anesthesia to work. How well a given anesthetic works is dependent upon your body composition, your health, what other medications you use, and the strengths or concentrations of the drugs being used.

All this must be taken into account by the anesthesiologist or anesthetist to safely maintain a pain-free state of unconsciousness. Some patients have a higher tolerance for anesthetics. This means that they need more medication to put them under or to stop pain than someone else of their size. We all know someone who can drink all coffee they want and go right to sleep and someone else who gets jittery and sleepless on a single cup a day. In the same way, people differ in the way they react to anesthesia. If you have ever had any kind of a problem with anesthesia, or if someone in your family has, tell both your surgeon and whoever is in charge of anesthesia for your surgery.

Who Will Administer Anesthesia?
In the United States, anesthesia is usually administered by an anesthesiologist (a physician trained in anesthesia and pain management) or a nurse anesthetist (a registered nurse with several years of training in administering anesthesia). In some cases, the surgeon may administer some types of anesthesia.

Nurse anesthetists deliver about 27 million anesthetics a year, according to their association, the American Association of Nurse Anesthetists. They can administer general, regional, and local anesthesia.

Anesthesiologists specialize in both anesthesia and in pain management. They may supervise anesthesia administered by nurse anesthetists or others.

Ask your abdominoplasty surgeon who will be administering anesthesia for you. This person will probably meet you before your tummy tuck surgery to discuss your anesthesia. For a full abdominoplasty, most surgeons use general anesthesia and it is often administered by an anesthesiologist.

While you are in surgery, and during recovery, you will be hooked up to monitors, blood pressure cuffs, and other devices that measure your vital signs. Whoever administers your anesthesia will monitor your heart rate, breathing rate, your blood pressure, and blood oxygen levels.

Your Choices In Anesthesia for Abdominoplasty Surgery
There are basically four types of anesthesia: local anesthesia, regional anesthesia (nerve blocks), sedation, and general (deep) anesthesia.

  • Local anesthesia
    Local anesthetics are what you have when you receive a shot to numb a relatively small treatment area. You most commonly receive a local anesthetic at the dentist's office or if you cut your hand and need stitches. Local anesthetics really don't play a role in an abdominoplasty, although if you are having only liposuction of your abdomen, you may be given a local anesthetic and sedation to keep you relaxed and drowsy.
  • Regional anesthesia
    In regional anesthesia, a region of the body is anesthetized without rendering the patient unconscious. The classic example is the types of anesthetics used in childbirth. However, regional anesthesia is rarely used in a tummy tuck.

    Regional anesthesia, sometimes referred to as a nerve block, is used in conjunction with sedation in some tummy tuck procedures. A nerve block is an anesthetic injected into a nerve cluster that affects sensation in the areas this cluster controls.

    Sometimes when the needle strikes a nerve you will feel a title jolt or shock. It can be uncomfortable, but it works very fast this way and you need fewer injections than with typical local anesthetic.

  • Sedation
    Sedation can be in the form of oral or intravenous (IV) medications. Sedatives, of which there are many, are drugs that are calming or which induce sleep. They can also provide some ease of mind, loss of memory, or can make you unconscious, which means that you can have a local or regional anesthetic for pain relief.

    You may be given a combination of IV or oral drugs, or gas and oral, with the oral sedative being given first so that you are calm before the IV is started. Even if you are being given an inhaled anesthetic, you will probably have an IV started so that fluids can be administered and injectable drugs can be used if needed.

    An IV is usually started before you get into the actual operating room and will have a bag of sterile saltwater (saline) hooked up to it. The tube going into your arm is called a catheter. Medications will be administered along with the saline. The saline will keep you hydrated during and after surgery.

    Usually, an IV is inserted into the arm at the elbow, but sometimes it is inserted into the hand. Sometimes, the IV leaves a bruise. I dislike the ones in the hand, since it's a nasty place for a bruise. At least with the arm you can hide it. Placement of the IV depends on your veins, though.

    With IV anesthetics, the anesthesiologist or anesthetist will insert a syringe into the IV line to inject the anesthetic or attach a bag of anesthetic that slowly drips in. The effects of the anesthesia are felt very soon – a few seconds in fact – after injection or after the bag of medication is attached and opened. It may feel like heat going into your veins then creeping up your arm, and then you are blissfully anesthetized. I have had several forms of IV sedation and actually prefer it.

    Oral sedation is basically taking a pill or capsule such as such as Valium (diazepam) or Xanax (alprazolam) by mouth an hour or so before a procedure. Oral sedatives make you very calm, drowsy, even peaceful, and you may even fall asleep, depending upon the dosage. Even if you are having general anesthesia, you may be given an oral sedative beforehand just to take the edge off any anxiety you may feel.

  • General anesthesia
    General can be given using an inhaled gas or by an IV or both simultaneously. You are completely unconscious during the surgery.

    If you are having gaseous general anesthesia, what you remember depends upon your anesthesiologist's preferences. If your anesthesiologist prefers to start with IV sedation, you will only remember the experience of having the IV started. If your anesthesiologist prefers to start with gas, he or she will put the mask on your face and you won't remember much more than that. After you are under, they will put a tube down your throat to continue administering the anesthetic gas.

    Take note of this: If you have asthma, get bronchitis often, or have other breathing disorders, make sure the anesthesiologist or anesthetist knows. Putting a tube down the airway may be irritating to the airways for you unless certain precautions are taken. Please make sure you read the risks associated with anesthesia, below.

    Twilight sleep (basically a weak form of general anesthesia) can be done with inhaled anesthetics, with no intubation. I have had this and find it to be really mild and fast acting. The good thing about this type of anesthesia is that as soon as they remove the mask you start coming to.

 Why Shouldn't I Eat Before Tummy Tuck Surgery?
You are often told not to eat anything after midnight the night before your surgery if your surgery is scheduled for the morning. You may be allowed to take a few sips of water if you need to take a pill in the morning.

Having an empty stomach reduces the risks of your throwing up or regurgitating stomach contents during surgery. Some anesthetics interfere with your normal reflexes, such as the one that helps keep you from inhaling food down into your lungs. Regurgitated food can enter the lungs or block the windpipe, which is a serious hazard while you are anesthetized. Your doctor will tell you specifically how long you need to fast before your surgery. If you eat before surgery, your surgery may be cancelled or postponed.

 Recovery From Anesthesia
Coming out of anesthesia is a very important time. You may feel sleepy, cold, achy, and out of it.

You will be monitored during recovery to ensure that any adverse events are rapidly recognized and treated. Sometimes you will become conscious in the operating room, but usually after general anesthesia, you come to in a recovery area. Here, nurses or other staff will keep an eye on you to watch for any postanesthesia complications..

When I begin to regain consciousness after anesthesia, I feel very cloudy, like my peripheral vision is gone temporarily and everything is of a white, blanched hue. I get emotional sometimes, and this is very normal. Some people immediately return to normal after coming to, some cry, but most report a sluggish feeling in their limbs. This will pass. You may think that you didn't even have your surgery because it feels as if you only just went to sleep.

 Nausea After Anesthesia
Some people may become nauseated as they come to, so alert one of the nurses if this happens to you. He or she can give you a few ice chips to suck on to help stave off the nausea, or at least give you something in which to throw up. Some surgeons give an antinausea medication to decrease your risks of vomiting after your surgery.

Some patients feel very cold and start shivering as they come out of anesthesia, so if you feel chilly, let the recovery room staff know. They have warm blankets available.

Risks, Contraindications and Complications of Anesthesia
Please understand that the risks described here are very rare. That does not mean that they do not exist. You should know about them, but you don't need to worry too much about these things happening to you.

Most cases of anesthesia-related death are usually linked to the respiratory system; in other words, problems that cause you to stop breathing or not get enough oxygen. These could be due to an allergic reaction to the drugs, a misplaced breathing tube, or problems with delivery of inhaled medications or oxygen, among other reasons. As mentioned before, a patient might choke on something coming up from the stomach.

Allergic reactions to any of the medications being given during surgery, most of which are anesthetics, can cause a heart attack or cause the airways of the lungs to tighten up or shut down.

Pre-existing heart conditions or problems of the liver or kidneys can also affect how various anesthetic drugs act in the body. This may mean that the amount being administered has a stronger or weaker effect than intended, leading to complications.

If you smoke, you are more likely to have lungs and bronchial tubes that are irritable and susceptible to spasm. This can also increase the risk of a complication with anesthesia.

Medication and Supplement Contraindications Regarding Anesthesia
There are several medications supplements that can interact with anesthesia. Make sure that your surgeon and anesthesiologist or anesthetist have a complete and honest list of every medication that you take regularly or occasionally. This list should include vitamin and mineral supplements, herbal supplements or remedies, and any recreational drugs that you use.

Here is a partial list of herbal products that can interfere with anesthesia.

  • Ginseng
  • St. John's Wort
  • Yohimbe, ("natural Viagra")
  • Licorice root (most licorice candy does not contain real licorice flavoring, but read the label)
  • Melatonin
  • Echinacea

This is not a complete list and you should consult with your surgeon or the person administering anesthesia. Follow their instructions about what is safe for you to continue taking while you have surgery and what you should stop taking for a while. However, many herbal products have not been studied for any interaction with other drugs and many doctors are not as knowledgeable as they could be about herbal remedies and dietary supplements.       

 Special medication alerts
If you are on antidepressants, please advise your doctor. Some antidepressants are in a drug category called monoamine oxidase (MAO) inhibitors (also known as MAOI). They can intensify the effects of anesthesia, especially general anesthesia. Tell your doctor or the anesthesiologist that you take an MAO inhibitor, or if you have taken one in the last few months, so that he or she can make adjustments for your anesthesia and monitor your heart or breathing rate. Drug interactions can occur even weeks after discontinued use of an MAO inhibitor.

MAO inhibitors include phenelzine (Nardil, Nardelzine), tranylcypromine (Parnate, Sicoton), isocarboxazid (Marplan), moclobemide (Aurorix, Manerix, Moclodura), and selegiline. These drugs are used for the treatment of depression, obsessive-compulsive disorder, eating disorders, essential hypertension (pargyline), chronic pain syndromes, and migraine headaches.

 In Conclusion
The information about anesthesia that I am giving you is not meant to scare you, but rather to inform you so that you are able to make a well-educated decision. Remember, thousands of people undergo anesthesia safely every day. Any problems due to anesthesia are very rare. Please don't let fear of anesthesia be the factor that kept you from having your tummy tuck surgery – just know that these complications are possible.