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Guide to Anesthesia

Anesthesia can be a concern for some, and for others can actually be frightening. In the many years that Dr. Robert N. Young has been performing reconstructive and cosmetic plastic surgeries, he has heard many stories from his patients. Some people become frightened at the thought of "going under", the unknown, loss of control, or perhaps have heard stories on television, or through friends and acquaintances which may scare them.

Dr. Young is fortunate to work with highly skilled anesthesiologists in his cosmetic plastic surgery practice in San Antonio. Dr. Mark Melish has worked side by side with Dr. Young for 20 years, and is considered one of the areas best. Dr. Melish has graciously agreed to share information which we hope will help you feel better prepared for your consultation visit and surgery with Dr. Young at Aesthetic Enhancement's Surgery Center.


About Your Anesthesia

by Mark A. Melish, M.D.
Diplomate, American Board of Anesthesiology

You are excited! You have finally scheduled a consult to discuss the surgery you've wanted. You are also a little bit anxious and you notice your anxiety increases especially about your anesthesia. Your feelings are entirely normal and very common. To ease your anxiety, I have answered some of the most common questions concerning your anesthesia.

Why should I have anesthesia when other surgeons say they can do the same procedure while I'm awake?

I am so glad you asked! This is a very important question because many doctors that talk about local anesthesia or being "awake" at not being entirely truthful. Many doctors consider you awake if you can talk, even if you are slurring your speech or mumbling. Their "awake" procedure very often involves giving you powerful intravenous or oral narcotics or sedatives. Since they are not giving a "complete anesthetic" they do not consider it an anesthetic at all. They have had little or no training in the use of these drugs in this way.

Anesthesia is not black or white and people differ in their sensitivities to medications. The same dose of medication may have minimal effect on one person and yet completely render another person unconscious to the point they lose their airway and protective reflexes or stop breathing. Furthermore, you may have minimal monitoring and the one doing the monitoring may be the person doing the procedure or someone inadequately trained. The local anesthesia involves only local anesthetic like lidocaine. At Aesthetic Enhancement, you are being monitored and medicated by Board Certified Anesthesiologists (MD's) who have done four years of post medical school training.

Your surgeon and anesthesiologists have privileges to do these procedures at major hospitals but choose our certified Outpatient Surgery Center for privacy, comfort and convenience, not because we have to. See if any other doctor you may be considering could get those privileges at a hospital if they wanted to. They may also play down the risk of their type of anesthesia and even claim that it is safer. They may have no other choice.

What are your anesthesiologist's credentials?

I am Board Certified by the American Board of Anesthesiology, and an honor graduate of Southwestern Medical School in Dallas. I did my internship in General Surgery and residency in anesthesiology at the University of Texas Health Science Center at San Antonio. I have been in private practice for 21 years and have specialized in anesthesia for Plastic Surgery, working closely with Dr. Young and Aesthetic Enhancement for 20 years. Other anesthesiologists who work with Dr. Young have similar training and experience.

When will I meet my anesthesiologist?

With the advent of outpatient surgery, you will probably not meet your anesthesiologist until just prior to your surgery. At that time, you will be questioned about your medical and surgical history, medication allergies, medications you are taking as well as any prior problems with anesthesia you or close blood relatives have had. All "medications" include prescription, over the counter, herbs, vitamins, weight loss pills that you take on a regular basis. Please let us know if there is any possibility of you being pregnant. Don't be offended if we run a pregnancy test as patients who said there was "absolutely no way", have indeed been pregnant. We do this for your protection as well as ours.

Dr. Young's office will usually let me know ahead of time if there are any medical conditions which require further information or work-up from your family doctor. Any information you can bring from your doctor or past hospitalizations is extremely helpful. We have the utmost interest in your safety so it is important to not keep any medical information from us, even if you don't think it is important. Any information disclosed will be kept in strict confidence and only discussed with the physicians responsible for your care. You will be given the opportunity to ask your anesthesiologist any questions you may have concerning your surgery and anesthesia. If you are extremely anxious about your anesthesia or have special problems, Dr. Young's office can arrange for you to speak with your anesthesiologist (usually by phone) prior to your day of surgery.

What kind of and how much anesthesia will I have?

The type of anesthesia you will receive depends on many factors including what procedures(s) you are having, the position you will be in, your prior medical condition, how long it will take and how anxious you are. Most of our procedures are done under a general anesthetic although we may use sedation with local anesthesia if we can do it safely and comfortably. If we have to give you high doses of sedation to do the surgery with "local anesthesia" you maybe essentially getting a "general anesthetic" with LESS safety margin than with a well controlled and planned general anesthetic.

Anesthesia is a dynamic process with continuous adjustment of your anesthesia level throughout your procedure. I usually use a mixture of intravenous and inhalation (gas) anesthesia for maximum advantage. The medications that initially put you to sleep would only keep you anesthetized for a few minutes without additional anesthesia.

Regardless of the type of anesthetic you receive, you will be monitored with an automatic blood pressure cuff, EKG, and a device that measures your oxygen saturation in your blood by shining a light through your finger (pulse oximeter). When you have a general anesthetic, a special monitor to watch the gases going in and out of your lungs is used. Other special monitors maybe required from time to time depending on your procedure and medical condition. The improvement and advances in anesthesia monitoring technology have dramatically improved anesthesia safety.

At the Surgery Center at Aesthetic Enhancement, you will be monitored as you would in any top hospital's certified operating room because WE ARE a certified surgical center.

I have heard that you may have a sore throat after surgery. What causes this?

Unlike natural sleep, the muscles and structures that compose the passages of your airway become lax during anesthesia. Your normal protective airway reflexes are blunted as well. After you are asleep, for your safety, I will insert a tube through your mouth to protect and maintain your airway. This tube will be removed before you are fully awake and aware and if it weren't for a scratchy or sore throat, most people would never realize that anything had been there. There are different types of tubes and for many procedures I use a very soft rubber tube which just rests in the back of your throat.

Not everybody gets a sore throat.....

Although the thought of these tubes may disturb some people, they are very much for your safety as they would allow me to take instant action if you should have any difficulty during the procedure (as opposed to the "awake" method where you would need to wait for an emergency EMT crew to arrive and intubate you if you should develop breathing difficulty or stop breathing altogether).

Why can't I eat before surgery?

You are given instructions not to eat for at least eight hours prior to surgery. This is done to prevent you from vomiting as you go to sleep which could get into your lungs and cause a very serious, life-threatening pneumonia. Compliance with this is very important for your safety and your surgery will probably be canceled if you don?t follow this simple but important rule. You may be instructed to take your morning blood pressure or other medications with a sip of water.

Should I take my daily medicines before surgery?

Yes, you should take your regular medicine before surgery especially blood pressure, heart, asthma and seizure medicine. Try to take them with water no later than three hours before surgery. If you use any inhalers for asthma or other breathing problems bring them to the surgery center with you.

An exception concerns diabetic medicine - both oral and insulin. We usually do not have you take your diabetic medicine prior to surgery since you won't be eating. If your surgery is late in the day and you will be eating some breakfast, we may have you take your medicine. Please ask us about this.

I don't want to throw up after surgery - is there anything you can do about this?

We attack this problem aggressively. Unfortunately, some procedures and people have a higher incidence of associated nausea and vomiting. Because of my experience, multiple medications are used to prevent this as much as possible. Our rate of nausea and vomiting is low because of this aggressive treatment. If you have had frequent persistent problems with post operative nausea or vomiting, please tell your nurse at your pre-op visit. There are new medications that can be prescribed and taken before your procedure that have been shown in our practice to be very beneficial.

Also, unfortunately, the pain medications you are given both immediately post-op and for home can cause nausea/vomiting. We attempt to use other methods to treat the pain including local anesthesia (even during a general anesthetic) so we don't have to use as many narcotics.

What are the risks from anesthesia?

Anesthesia is now the safest it has ever been thanks to advanced technology, better medications with less side effects, and better training of anesthesiologists. Risks include everything from heart and lung problems to damaged teeth to allergic reactions to rare diseases, which can happen during anesthesia. Of course, the more medical problems you have, the higher your risk may be. You will not have your elective surgery unless your pre-existing medical conditions are under good control. We therefore need to know as much as we can about your medical history no matter how trivial you believe it to be.

Myself (Dr. Melish) or another anesthesiologist , who are physicians, will administer your anesthesia. He/she will be in the operating room throughout your entire procedure. Safety is our number one priority. You probably take a bigger risk driving to the hospital than having your surgery.

What about these horror stories about fires during laser surgery?

Dr. Young and myself are thoroughly trained in preventing this rare but destructive occurrence from happening. Every precaution is taken including protecting your eyes, protecting the breathing tube from getting hit by the laser and adjusting the lowest safe oxygen level necessary for you to breathe. Every detail is continually monitored even when not using the laser.

What about stories on TV about people being awake during their surgery?

It is extremely rare these days to have any recall from anesthesia. The new medications we use have excellent amnesic qualities. We also have monitors that tell us if we are delivering the amount of gas we turn the machine to. We usually give more medicine than is probably necessary to keep recall from happening.

In an emergency, if the gas were to be turned off for an extended period of time and no intravenous medicine were additionally given, then it is possible for recall to happen, but we are very cognizant of that. Additionally, people who are on chronic Valium, Xanax, Ativan, or other Benzodiazepines maybe at higher risk of having recall because their brain has adapted to these medicines. Again, I recognize this and treat accordingly.

When will I get medicated for my anxiety?

Since Dr. Young often has to have you stand to put marks on you, we don't usually medicate you till after you are marked. We also want the nurse to check your permit before medicating you so that if changes need to be made, you can legally sign. We then medicate you once these things have been done - prior to going into the operating room. If you are extremely nervous, we can give you a prescription for something to take the night before or the morning of surgery.

I probably have not answered every question you may have about anesthesia but hopefully have answered the biggest ones. Feel free to contact us to ask any other questions you may have at any time. My goal is to alleviate as much anxiety as I can and to provide you with the best experience possible.

- Dr. Mark A. Melish


For more information about specific cosmetic plastic surgery procedures which are performed by San Antonio's renowned Board Certified Plastic Surgeon Dr. Robert Young, give us a call today.

We look forward to helping you achieve your personal cosmetic goals. Discover why Dr. Robert N. Young has such an outstanding reputation and enjoy that he is committed to excellent patient care at very affordable fees.



Call us now to schedule your own private cosmetic consultation and learn more about Breast , Body or Facial Surgery with Dr. Young.

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