Aug. 20, 2024
Sweet Dreams, Comfortable and Safe Anesthesia w/ Dr. Kalman Friedman
It’s normal to feel nervous about anesthesia. Seasoned anesthesiologist Dr. Kalman Friedman joins Dr. Bass to dive into anesthesia and safety to alleviate the common anxiety of “going under.”
From local anesthesia, to general anesthesia, to IV sedation, options are available when it comes to how you want to stay comfortable during your cosmetic procedure. Learn the advantages and disadvantages of each and find out which is the better fit for you.
Modern anesthesia has significantly improved in safety thanks to advanced medications, better scientific understanding, and enhanced monitoring devices. Many newer drugs avoid the "anesthesia hangover" that was once common.
Drs. Bass and Friedman debunk myths about anesthesia, including the use of breathing tubes.
About Dr. Kalman Friedman
Dr. Kalman Friedman is a senior anesthesiologist with Caliber Anesthesia in New York who has kept plastic surgery patients up and down Park Avenue safe and comfortable during their procedures. He and Dr. Bass have several years of experience working together to give patients the best results in the safest way possible.
Learn more about Caliber Anesthesia
About Dr. Lawrence Bass
Innovator. Industry veteran. In-demand Park Avenue board certified plastic surgeon, Dr. Lawrence Bass is a true master of his craft, not only in the OR but as an industry pioneer in the development and evaluation of new aesthetic technologies. With locations in both Manhattan (on Park Avenue between 62nd and 63rd Streets) and in Great Neck, Long Island, Dr. Bass has earned his reputation as the plastic surgeon for the most discerning patients in NYC and beyond.
To learn more, visit the Bass Plastic Surgery website or follow the team on Instagram @drbassnyc
Subscribe to the Park Avenue Plastic Surgery Class newsletter to be notified of new episodes & receive exclusive invitations, offers, and information from Dr. Bass.
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Welcome to Park Avenue
Plastic Surgery Class,
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the podcast where we explore controversies
and breaking issues in plastic
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surgery. I'm your co-host Doreen Wu,
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a clinical assistant at Bass
Plastic Surgery in New York City.
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I'm excited to be here with Dr. Lawrence
Bass, Park Avenue plastic surgeon,
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educator and technology innovator.
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The title of today's
episode is "Sweet Dreams,
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Comfortable and Safe
Anesthesia." Dr. Bass,
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as we've said many times on the
podcast, we all want to be beautiful,
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but some of us are afraid
of the experience or the
risks involved with having
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plastic surgery. What would you say
to those of us in that category?
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Everyone would like to achieve
the results they're after in the
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least invasive way possible,
ideally without surgery.
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And there's been a revolution in the
past three decades in aesthetic medicine
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and plastic surgery with
many nonsurgical offerings,
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which are extremely valuable. However,
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plastic surgery is still often
the only meaningful option
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depending on what stage of aging
you're at or which beauty feature is
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involved. Fortunately,
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there's been a revolution in how and
where aesthetic plastic surgery is
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performed over those
same past few decades.
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Some of this is fueled by the advent
of minimally invasive procedures,
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and the evolution of open
surgery has been refined and
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focused.
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almost all aesthetic plastic
surgery procedures in almost all
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patients can be performed
in an office operating room,
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which in compliance with accreditation
standards for such facilities
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provides a very safe, private,
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and comfortable setting to
obtain your plastic surgery.
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Safety and comfort are the key.
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Much of what has enabled this
shift to office surgery relates to
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improvements in anesthesia.
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This follows the same pattern as what has
happened with non aesthetic surgery in
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the United States with a shift
of a large percentage of all
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procedures to an ambulatory
setting without a hospital
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stay.
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Going under anesthesia is a source of
concern to many as much as the surgery
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itself. How much should I worry?
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As I said, modern anesthesia has
made tremendous advancements.
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I've asked one of the senior
hangoveranesthesiologists
from the group that works
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with my practice to discuss
some of these issues.
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Dr. Kalman Friedman is a senior
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anesthesiologist with the Caliber
Anesthesia group. As I said,
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they provide anesthesia services
in my practice and for many
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other esteemed plastic surgeons
up and down Park Avenue
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in New York City.
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He also has a great deal of experience
in running and managing ambulatory
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surgery centers and all of the demands of,
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of ambulatory anesthesia and
distinction from hospital
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surgery. Welcome, Dr. Friedman.
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Thank you. It's a pleasure and an
honor to join Dr. Bass on this podcast.
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So, Dr. Friedman,
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can you tell us what kinds of anesthesia
are typically options for office-based
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plastic surgery?
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So most office-based plastic surgery
is done under either general anesthesia
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or IV sedation or MAC,
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what some may call twilight
IV sedation kind of runs on a
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continuum. At one end,
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it could be just a bit of medication to
relax you while the numbing medicine is
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injected to the other end,
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deeply asleep or anything in
between tailored to the situation.
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And how risky is that really?
How worried should I be?
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It's very normal for a patient to be
apprehensive regarding having anesthesia.
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However, nowadays with advances in
medications, our scientific knowledge,
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and our monitoring devices, anesthesia
is very, very safe. Of course,
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there is always some degree of risk.
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One must accept and undergoing any
procedure, but it is extremely minimal.
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The risk of having any
anesthetic related problem,
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let alone a serious
problem, is very, very low.
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One of my mentors used to tell all of
his patients that it is safer to go under
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general anesthesia than it
is to cross the streets,
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not the way we usually look at
things, but it is certainly true.
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And I think that that's absolutely right.
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The anesthesia capabilities in terms of
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monitoring and keeping
an eye on patients' vital
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signs,
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oxygenation is a totally different
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place than where it
was a few decades back.
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That greatly amplifies safety
and many of the medications
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are short acting without
the anesthesia hangover.
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That was true 40,
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50 years ago. That allows
people to wake up quickly,
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feel well, and be ready to go home.Well,
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let me ask you this, Dr. Friedman.
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A a lot of patients feel that
general anesthesia has more risk than
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IV sedation. Is that true? I mean,
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why do patients think that
and and what are the issues?
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That's a great question.
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It is probably the most common question
I get from patients and find myself
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discussing this with patients.
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So I'll spend a few extra
minutes on this question.
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I'll start off by saying that both
general anesthesia and IV sedation are
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both very safe.
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There are some surgeries where one
is more appropriate than the other,
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often either can be done and there
is a discussion between the surgeon,
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the anesthesiologist, and the
patient to find the best fit.
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I do want to clarify that with both
general anesthesia and sedation,
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the patient is asleep and safe.
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The real big difference is in
the level or depth of anesthesia.
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And that is usually dictated
by the nature of the surgery.
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I think what you are referring to Dr.
Bass is the breathing tube or being
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intubated.
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What comes to mind for some people is
a patient on a ventilator in the ICU or
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they imagine someone putting a breathing
tube down their throat while they're,
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they are in, in reality,
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most of the time we could form a general
anesthetic with a so thro airway device
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called the LMA that sits in the back of
the tongue and the patients breathe on
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their own through this device. It is
placed when the patient is a sleep and is
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removal, which before the
patient wakes up. In reality,
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most considered general
anesthesia as safer,
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given that the airway is secured with
the LMA or a similar such device.
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And I think that's a really
important point that often
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general anesthesia is going to be a more
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even level of oxygen intake,
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a more even level of blood pressure
than something that's done under
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local anesthesia or with
the barest minimum of
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sedation. So in that sense,
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it's less physiological stress and
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really a safer experience overall.
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And the other point you made that I
thought was really important is that,
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that the magnitude of the surgery often
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dictates what level of anesthesia
is required for someone to be
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completely comfortable while
the procedure is going on.
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So that kind of drives the
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situation to some extent
in terms of anesthesia
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selection, and it's important
for patients to realize that.
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But Dr. Bass, can I just have my
procedure under local anesthesia?
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As the surgeon,
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what do you think about having more
anesthesia versus just having local?
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What's your take on this?
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As I said, you know, a lot of it has
to do with the extent of the procedure.
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If you're having a skin biopsy
or an earlobe repair the
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local anesthesia works perfectly
well. You're very comfortable,
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it's easy to do. The procedure is short,
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and so it's easy to sit still for a few
minutes while the procedure's completed.
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But as the procedure
gets larger in magnitude,
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the length of the
procedure becomes longer.
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It gets harder to manage that just
under local in a way that's really
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comfortable for people.
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And so having a comfortable
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experience and gauging the
amount of that you have as
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an individual is important in deciding
what kind of anesthesia is really going
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to be right for you.
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Some people are a lot
more anxious than others.
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Some people just seeing the operating
room, hearing the monitors beeping,
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really gives them a lot of anxiety,
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or in some cases a panic attack.
In those circumstances,
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enough anesthesia to be
relaxed, comfortable,
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or even asleep and dozing
is going to be more
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appropriate.
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So you can get through the procedure
and it's not a in ordeal for
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you to go through.
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The other thing is when
the anesthesiologist is
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present in the operating room,
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it allows the surgeon to
focus just on the surgery,
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concentrate on giving
you the most precision,
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the most artistry,
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the most perfect result
that's possible rather than
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having to split attention
between the procedure,
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your vital signs and
your state of mind and
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level of comfort having excellent
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anesthesia allows for very extensive
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interventions. It allows you to
push the procedure to the maximum.
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Perfect example of this is liposuction.
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A lot of liposuction is done
just with tumescent anesthesia,
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essentially local anesthesia.
And for small liposuction,
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that works well in some cases.
But if you're trying to treat two or
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three areas where you're really trying
to bring things down to the barest
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minimum of fat,
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that's a lot more stimulating
and uncomfortable.
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And you may succeed better
at achieving your goals if
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the procedure is done under
anesthesia and it lets you do multiple
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procedures at once.
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And having another physician
there who's an expert in
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cardiac and pulmonary physiology and
understands how to monitor and manage
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that makes you safer, it reduces
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again, the split attention of the
rest of the staff in the room.
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So I think those are some
of the reasons why as
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the procedure becomes
substantial and magnitude,
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anesthesia is really the right way to go.
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I think Dr. Bass covered
all the points. Of course,
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for certain minor procedures that
can be numbed up completely and the
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cooperative patient,
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it can be done safely and comfortably
with just a local anesthesia.
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I'll just add that I hear from colleagues
of mine at other practices that
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they're tending to do procedures
that should have an anesthesiologist,
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and for one reason or another, they
decide to do with just local anesthetic.
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They run into all the issues
that Dr. Bass mentioned.
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The surgeon is preoccupied with an
uncomfortable and often swarming around
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patient.
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There are also practices that will heavily
sedate the patients themselves under
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the disguise of a local anesthetic
without an anesthesiologist where we not a
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good and safe idea.
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And an important thing about
that is that, you know,
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it varies in each individual state,
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but in New York state where
Dr. Friedman and I practice,
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there are very specific rules about
what procedures can be done in
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just an office operating room and
what has to be done in an accredited
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office operating room,
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and how much sedation
can be given if it's not
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given by an anesthesiologist
or other qualified
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anesthesia provider.
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So the idea of taking an
awful lot of oral medicine,
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which has variable absorption
really is not a safe approach.
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And if the procedure is of a
sufficient magnitude to require
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that,
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it's better to have
the quality and control
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of having an anesthesiologist who
can make sure that you're safe
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and comfortable.
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Now, let's look on the flip side.
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What are the disadvantages
of having more anesthesia?
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So of course, you know,
there's a cost to everything.
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So if you're bringing
an anesthesia provider,
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the anesthesiologist adds a
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cost medical clearance will
be required over a certain
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age.
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And people who have had anesthesia
need to go home with an escort. Again,
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in our state, New York
state, that's mandatory.
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And of course there's a little
bit of time to recover from the
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anesthesia. For minor
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procedures or a small single
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intervention, those may be unnecessary
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added impediments.
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But if you start to get to
a more extensive procedure,
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even if you do it under local,
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you're not going to be good
to drive yourself home.
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You're going to need an escort.
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You may need medical clearance if you're
older or have medical conditions just
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for the surgery to be performed safely.
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So you're not necessarily
foregoing all of those
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disadvantages just because
you're doing it under local.
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Okay. So now, Dr. Friedman, I want
to pick your brain for a moment.
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I wonder what do you feel
are the advantages of care
in the office setting and
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with the kind of ambulatory
anesthesia that is available today?
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I just want to start off saying that
today the majority of all surgeries are
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done in an ambulatory setting.
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I am not just talking about elective
cosmetic surgeries that we're discussing,
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but hernia repairs, tonsillectomies,
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knee and shoulder repairs are all
mostly done in the ambulatory setting.
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The advantages are manyfold.
I'll start off with safety.
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The risk of acquiring infections
is lower, medical error is reduced.
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The surgeon has what we'll
call home court advantage,
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having his handpicked
instruments, nursing staff,
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anesthesiologist. From
that anesthetic end,
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ambulatory anesthesia has
become a specialty on its own,
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meaning that your anesthesiologist,
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who will be taking care of you in the
office setting has been trained and has
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experienced this. We have the
same medication, supplies,
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and equipment available
as in the hospital,
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and are trained to deal with any
situation that can arise. And of course,
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you have the convenience factor.
Anyone who has had to deal with hospital
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bureaucracy knows this all too well,
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your surgery starts on time
and not delayed many hours
into the afternoon while
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you are still NPO not eating
or drinking for the morning.
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The patient's responsibility for facility
costs are usually much lower than an
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alternative setting as well.
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00:15:55,850 --> 00:15:58,790
You'll also know beforehand who
your anesthesiologist will be,
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and he or she will call you before and
go through your medical history and will
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discuss the anesthetic options
and plans. At this time,
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you would also have the opportunity to
ask any questions and then discuss any
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particular concerns that you may have.
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Finally, before we conclude Dr. Bass,
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what should our listeners take
away from today's episode?
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So I think there are a number of important
points that, that I could summarize.
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As you heard, you know,
anesthesia's very safe.
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There's a small risk, not zero,
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because there's not zero
risk in anything we do in
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life. And, and it's very
much like driving a car.
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Every time you get in the car and drive
somewhere something terrible could
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happen. You could get in an
accident, but the chance is very low.
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So you don't hide at
home in a dark corner.
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You get in the car and
drive. But you know,
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you look both ways before you
pass into an intersection.
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You follow the rules of the
road and drive cautiously.
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And even though the risk isn't zero,
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you're very safe and you get a lot of
benefit from the mobility of being able to
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drive.
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Having anesthesia allows the
procedure to be very controlled.
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It's an added layer of safety overall for
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patients.
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And working in an office-based
surgical facility is private.
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It's cost effective,
comfortable. It's very efficient.
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As Dr. Friedman just pointed out,
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it's the whole team that's
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all optimized and used
to working together.
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Dr. Friedman knows what I'm going
to do. I know what he's going to do.
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00:17:51,570 --> 00:17:53,700
We've worked together many, many times.
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It's not whoever the
hospital sends in that day
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with a brand new team almost
every day in the facility.
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And so overall,
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00:18:06,750 --> 00:18:10,890
this makes in office
plastic surgery the safest,
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most comfortable and
pleasant experience possible.
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For aesthetic plastic surgery. You know,
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the plastic surgery experience
is about service, comfort,
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privacy,
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00:18:25,230 --> 00:18:30,030
and getting the chance to
enjoy making yourself image
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according to your
desires. It's a boutique,
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premier experience,
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00:18:37,890 --> 00:18:41,640
the best in quality and with safety most
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00:18:41,650 --> 00:18:46,650
important. The kind of
anesthesiologists who work in the
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office space plastic surgery
setting are committed to all of the
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00:18:50,940 --> 00:18:52,800
principles I just listed.
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Anesthesia advances have been
central to enabling that entire
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00:18:58,320 --> 00:19:02,430
experience, even for
extensive plastic surgery.
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00:19:03,420 --> 00:19:08,250
And it allows patients to be asleep
totally comfortable during even
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extensive procedures than wake up rapidly,
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be alert enough and comfortable
enough to walk out of the office,
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able to eat and drink and recover in
the comfort and privacy of their own
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00:19:21,210 --> 00:19:22,043
homes.
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Dr. Friedman, would you
like to add any takeaways?
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00:19:26,010 --> 00:19:29,220
That was a great discussion we had
today and hopefully informative to the
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00:19:29,220 --> 00:19:30,053
audience.
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00:19:30,650 --> 00:19:33,750
Remember that your anesthesiologist is
there to keep you safe and comfortable.
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00:19:34,530 --> 00:19:36,600
Consider him your primary
care doctor for the day,
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00:19:36,840 --> 00:19:40,500
and always discuss with him or her
all of your medical conditions and any
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00:19:40,500 --> 00:19:43,890
questions or concerns you have,
and you'll have a great experience.
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00:19:44,820 --> 00:19:48,810
Thank you Dr. Friedman and Dr. Bass for
sharing your insight and expertise on
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00:19:48,820 --> 00:19:51,120
this very important
topic in plastic surgery.
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00:19:52,020 --> 00:19:55,200
Thank you Dr. Bass for having me on
as a guest. And thank you, Doreen,
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00:19:55,200 --> 00:19:56,430
for hosting this discussion.
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00:19:57,030 --> 00:19:58,500
And thank you, Dr. Friedman,
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00:19:58,500 --> 00:20:01,890
for joining us and sharing
so much useful information.
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And thank you for providing such excellent
care along with the rest of your team
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00:20:07,110 --> 00:20:09,570
to my patients. I really appreciate it.
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00:20:10,350 --> 00:20:14,010
Thank you for listening to the Park
Avenue Plastic Surgery Class podcast.
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00:20:14,430 --> 00:20:16,650
Follow us on Apple
Podcasts, write a review,
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00:20:16,680 --> 00:20:18,030
and share the show with your friends.
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00:20:18,450 --> 00:20:21,540
Be sure to join us next time to avoid
missing all the great content that's
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00:20:21,540 --> 00:20:25,080
coming your way. If you want to
contact us with comments or questions,
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00:20:25,080 --> 00:20:25,980
we'd love to hear from you.
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00:20:26,460 --> 00:20:30,590
Send us an email at podcast@drbass.net
or DM us on Instagram
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00:20:30,960 --> 00:20:32,270
@drbassnyc.
00:00:00,660 --> 00:00:03,330
Welcome to Park Avenue
Plastic Surgery Class,
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00:00:03,570 --> 00:00:07,290
the podcast where we explore controversies
and breaking issues in plastic
3
00:00:07,290 --> 00:00:09,780
surgery. I'm your co-host Doreen Wu,
4
00:00:09,960 --> 00:00:13,170
a clinical assistant at Bass
Plastic Surgery in New York City.
5
00:00:13,620 --> 00:00:18,090
I'm excited to be here with Dr. Lawrence
Bass, Park Avenue plastic surgeon,
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00:00:18,360 --> 00:00:20,490
educator and technology innovator.
7
00:00:20,970 --> 00:00:24,000
The title of today's
episode is "Sweet Dreams,
8
00:00:24,150 --> 00:00:27,690
Comfortable and Safe
Anesthesia." Dr. Bass,
9
00:00:27,780 --> 00:00:31,320
as we've said many times on the
podcast, we all want to be beautiful,
10
00:00:31,440 --> 00:00:35,610
but some of us are afraid
of the experience or the
risks involved with having
11
00:00:35,620 --> 00:00:39,090
plastic surgery. What would you say
to those of us in that category?
12
00:00:39,720 --> 00:00:44,400
Everyone would like to achieve
the results they're after in the
13
00:00:44,400 --> 00:00:48,270
least invasive way possible,
ideally without surgery.
14
00:00:49,140 --> 00:00:53,430
And there's been a revolution in the
past three decades in aesthetic medicine
15
00:00:53,430 --> 00:00:57,660
and plastic surgery with
many nonsurgical offerings,
16
00:00:57,660 --> 00:01:00,870
which are extremely valuable. However,
17
00:01:01,080 --> 00:01:05,520
plastic surgery is still often
the only meaningful option
18
00:01:05,760 --> 00:01:10,650
depending on what stage of aging
you're at or which beauty feature is
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00:01:10,660 --> 00:01:13,320
involved. Fortunately,
20
00:01:13,320 --> 00:01:17,970
there's been a revolution in how and
where aesthetic plastic surgery is
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00:01:17,970 --> 00:01:22,050
performed over those
same past few decades.
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00:01:23,130 --> 00:01:27,660
Some of this is fueled by the advent
of minimally invasive procedures,
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00:01:28,680 --> 00:01:33,540
and the evolution of open
surgery has been refined and
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00:01:33,540 --> 00:01:34,380
focused.
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00:01:36,210 --> 00:01:40,650
almost all aesthetic plastic
surgery procedures in almost all
26
00:01:40,650 --> 00:01:44,640
patients can be performed
in an office operating room,
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00:01:44,970 --> 00:01:49,710
which in compliance with accreditation
standards for such facilities
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00:01:50,070 --> 00:01:53,880
provides a very safe, private,
29
00:01:53,880 --> 00:01:57,090
and comfortable setting to
obtain your plastic surgery.
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00:01:58,230 --> 00:02:00,660
Safety and comfort are the key.
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00:02:02,490 --> 00:02:06,450
Much of what has enabled this
shift to office surgery relates to
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00:02:06,480 --> 00:02:08,790
improvements in anesthesia.
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00:02:09,480 --> 00:02:14,370
This follows the same pattern as what has
happened with non aesthetic surgery in
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00:02:14,520 --> 00:02:18,780
the United States with a shift
of a large percentage of all
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00:02:18,780 --> 00:02:23,400
procedures to an ambulatory
setting without a hospital
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00:02:23,400 --> 00:02:24,233
stay.
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00:02:25,140 --> 00:02:29,610
Going under anesthesia is a source of
concern to many as much as the surgery
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00:02:29,610 --> 00:02:31,500
itself. How much should I worry?
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00:02:32,490 --> 00:02:36,120
As I said, modern anesthesia has
made tremendous advancements.
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00:02:36,510 --> 00:02:40,950
I've asked one of the senior
hangoveranesthesiologists
from the group that works
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00:02:40,960 --> 00:02:44,490
with my practice to discuss
some of these issues.
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00:02:46,230 --> 00:02:50,190
Dr. Kalman Friedman is a senior
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00:02:50,190 --> 00:02:54,270
anesthesiologist with the Caliber
Anesthesia group. As I said,
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00:02:54,270 --> 00:02:58,140
they provide anesthesia services
in my practice and for many
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00:02:58,150 --> 00:03:03,070
other esteemed plastic surgeons
up and down Park Avenue
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00:03:03,070 --> 00:03:04,180
in New York City.
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00:03:05,380 --> 00:03:10,030
He also has a great deal of experience
in running and managing ambulatory
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00:03:10,030 --> 00:03:14,500
surgery centers and all of the demands of,
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00:03:14,590 --> 00:03:19,080
of ambulatory anesthesia and
distinction from hospital
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00:03:19,090 --> 00:03:21,580
surgery. Welcome, Dr. Friedman.
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00:03:22,660 --> 00:03:26,800
Thank you. It's a pleasure and an
honor to join Dr. Bass on this podcast.
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00:03:27,550 --> 00:03:28,960
So, Dr. Friedman,
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00:03:28,960 --> 00:03:33,520
can you tell us what kinds of anesthesia
are typically options for office-based
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00:03:33,530 --> 00:03:34,420
plastic surgery?
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00:03:35,290 --> 00:03:40,060
So most office-based plastic surgery
is done under either general anesthesia
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00:03:40,390 --> 00:03:42,490
or IV sedation or MAC,
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00:03:42,730 --> 00:03:47,410
what some may call twilight
IV sedation kind of runs on a
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00:03:47,410 --> 00:03:49,000
continuum. At one end,
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00:03:49,300 --> 00:03:53,230
it could be just a bit of medication to
relax you while the numbing medicine is
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00:03:53,230 --> 00:03:55,600
injected to the other end,
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00:03:55,600 --> 00:03:59,800
deeply asleep or anything in
between tailored to the situation.
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00:04:00,700 --> 00:04:03,550
And how risky is that really?
How worried should I be?
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00:04:04,360 --> 00:04:08,680
It's very normal for a patient to be
apprehensive regarding having anesthesia.
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00:04:09,070 --> 00:04:13,840
However, nowadays with advances in
medications, our scientific knowledge,
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00:04:13,840 --> 00:04:18,550
and our monitoring devices, anesthesia
is very, very safe. Of course,
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00:04:18,550 --> 00:04:20,260
there is always some degree of risk.
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00:04:20,530 --> 00:04:25,270
One must accept and undergoing any
procedure, but it is extremely minimal.
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00:04:25,270 --> 00:04:28,060
The risk of having any
anesthetic related problem,
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00:04:28,060 --> 00:04:31,120
let alone a serious
problem, is very, very low.
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00:04:31,540 --> 00:04:35,350
One of my mentors used to tell all of
his patients that it is safer to go under
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00:04:35,350 --> 00:04:38,110
general anesthesia than it
is to cross the streets,
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00:04:38,530 --> 00:04:41,140
not the way we usually look at
things, but it is certainly true.
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00:04:41,770 --> 00:04:44,170
And I think that that's absolutely right.
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The anesthesia capabilities in terms of
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00:04:49,180 --> 00:04:53,500
monitoring and keeping
an eye on patients' vital
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00:04:53,500 --> 00:04:54,280
signs,
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00:04:54,280 --> 00:04:59,230
oxygenation is a totally different
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00:04:59,230 --> 00:05:02,080
place than where it
was a few decades back.
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00:05:02,710 --> 00:05:07,450
That greatly amplifies safety
and many of the medications
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00:05:07,750 --> 00:05:11,470
are short acting without
the anesthesia hangover.
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00:05:11,470 --> 00:05:15,010
That was true 40,
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00:05:15,010 --> 00:05:19,210
50 years ago. That allows
people to wake up quickly,
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00:05:19,210 --> 00:05:24,010
feel well, and be ready to go home.Well,
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00:05:26,170 --> 00:05:28,000
let me ask you this, Dr. Friedman.
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00:05:28,270 --> 00:05:32,980
A a lot of patients feel that
general anesthesia has more risk than
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00:05:33,340 --> 00:05:36,130
IV sedation. Is that true? I mean,
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00:05:36,130 --> 00:05:39,940
why do patients think that
and and what are the issues?
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00:05:40,840 --> 00:05:42,190
That's a great question.
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00:05:42,550 --> 00:05:45,940
It is probably the most common question
I get from patients and find myself
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00:05:45,940 --> 00:05:47,470
discussing this with patients.
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00:05:47,740 --> 00:05:49,960
So I'll spend a few extra
minutes on this question.
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00:05:50,350 --> 00:05:55,030
I'll start off by saying that both
general anesthesia and IV sedation are
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00:05:55,030 --> 00:05:56,050
both very safe.
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00:05:56,830 --> 00:05:59,810
There are some surgeries where one
is more appropriate than the other,
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00:06:00,380 --> 00:06:03,890
often either can be done and there
is a discussion between the surgeon,
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00:06:04,190 --> 00:06:06,980
the anesthesiologist, and the
patient to find the best fit.
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00:06:08,060 --> 00:06:12,590
I do want to clarify that with both
general anesthesia and sedation,
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00:06:12,590 --> 00:06:14,270
the patient is asleep and safe.
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00:06:14,520 --> 00:06:17,990
The real big difference is in
the level or depth of anesthesia.
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00:06:18,200 --> 00:06:20,690
And that is usually dictated
by the nature of the surgery.
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00:06:21,320 --> 00:06:24,680
I think what you are referring to Dr.
Bass is the breathing tube or being
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00:06:24,690 --> 00:06:25,523
intubated.
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00:06:25,820 --> 00:06:30,080
What comes to mind for some people is
a patient on a ventilator in the ICU or
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00:06:30,080 --> 00:06:32,960
they imagine someone putting a breathing
tube down their throat while they're,
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00:06:33,230 --> 00:06:35,390
they are in, in reality,
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00:06:35,390 --> 00:06:39,200
most of the time we could form a general
anesthetic with a so thro airway device
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00:06:39,260 --> 00:06:43,580
called the LMA that sits in the back of
the tongue and the patients breathe on
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00:06:43,580 --> 00:06:47,960
their own through this device. It is
placed when the patient is a sleep and is
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00:06:47,960 --> 00:06:51,020
removal, which before the
patient wakes up. In reality,
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00:06:51,020 --> 00:06:53,510
most considered general
anesthesia as safer,
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00:06:53,510 --> 00:06:57,440
given that the airway is secured with
the LMA or a similar such device.
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00:06:58,400 --> 00:07:03,110
And I think that's a really
important point that often
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00:07:03,950 --> 00:07:08,600
general anesthesia is going to be a more
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00:07:08,630 --> 00:07:11,450
even level of oxygen intake,
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00:07:11,480 --> 00:07:16,310
a more even level of blood pressure
than something that's done under
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00:07:16,320 --> 00:07:21,170
local anesthesia or with
the barest minimum of
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00:07:21,170 --> 00:07:23,210
sedation. So in that sense,
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00:07:23,210 --> 00:07:27,320
it's less physiological stress and
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00:07:27,870 --> 00:07:30,560
really a safer experience overall.
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00:07:31,280 --> 00:07:35,390
And the other point you made that I
thought was really important is that,
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that the magnitude of the surgery often
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00:07:40,250 --> 00:07:44,870
dictates what level of anesthesia
is required for someone to be
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00:07:44,880 --> 00:07:48,170
completely comfortable while
the procedure is going on.
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00:07:48,650 --> 00:07:52,640
So that kind of drives the
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00:07:52,650 --> 00:07:56,990
situation to some extent
in terms of anesthesia
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00:07:56,990 --> 00:08:00,260
selection, and it's important
for patients to realize that.
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00:08:00,920 --> 00:08:04,970
But Dr. Bass, can I just have my
procedure under local anesthesia?
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00:08:05,480 --> 00:08:06,350
As the surgeon,
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00:08:06,350 --> 00:08:10,190
what do you think about having more
anesthesia versus just having local?
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00:08:10,580 --> 00:08:11,630
What's your take on this?
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As I said, you know, a lot of it has
to do with the extent of the procedure.
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If you're having a skin biopsy
or an earlobe repair the
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local anesthesia works perfectly
well. You're very comfortable,
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it's easy to do. The procedure is short,
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and so it's easy to sit still for a few
minutes while the procedure's completed.
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But as the procedure
gets larger in magnitude,
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the length of the
procedure becomes longer.
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It gets harder to manage that just
under local in a way that's really
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comfortable for people.
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And so having a comfortable
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experience and gauging the
amount of that you have as
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an individual is important in deciding
what kind of anesthesia is really going
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to be right for you.
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Some people are a lot
more anxious than others.
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Some people just seeing the operating
room, hearing the monitors beeping,
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really gives them a lot of anxiety,
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or in some cases a panic attack.
In those circumstances,
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enough anesthesia to be
relaxed, comfortable,
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or even asleep and dozing
is going to be more
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appropriate.
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So you can get through the procedure
and it's not a in ordeal for
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you to go through.
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The other thing is when
the anesthesiologist is
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present in the operating room,
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it allows the surgeon to
focus just on the surgery,
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concentrate on giving
you the most precision,
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the most artistry,
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the most perfect result
that's possible rather than
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having to split attention
between the procedure,
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your vital signs and
your state of mind and
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level of comfort having excellent
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anesthesia allows for very extensive
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interventions. It allows you to
push the procedure to the maximum.
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Perfect example of this is liposuction.
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A lot of liposuction is done
just with tumescent anesthesia,
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essentially local anesthesia.
And for small liposuction,
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that works well in some cases.
But if you're trying to treat two or
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three areas where you're really trying
to bring things down to the barest
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minimum of fat,
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that's a lot more stimulating
and uncomfortable.
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And you may succeed better
at achieving your goals if
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the procedure is done under
anesthesia and it lets you do multiple
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procedures at once.
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And having another physician
there who's an expert in
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cardiac and pulmonary physiology and
understands how to monitor and manage
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that makes you safer, it reduces
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again, the split attention of the
rest of the staff in the room.
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So I think those are some
of the reasons why as
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the procedure becomes
substantial and magnitude,
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anesthesia is really the right way to go.
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I think Dr. Bass covered
all the points. Of course,
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for certain minor procedures that
can be numbed up completely and the
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cooperative patient,
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it can be done safely and comfortably
with just a local anesthesia.
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I'll just add that I hear from colleagues
of mine at other practices that
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they're tending to do procedures
that should have an anesthesiologist,
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and for one reason or another, they
decide to do with just local anesthetic.
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They run into all the issues
that Dr. Bass mentioned.
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The surgeon is preoccupied with an
uncomfortable and often swarming around
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patient.
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There are also practices that will heavily
sedate the patients themselves under
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the disguise of a local anesthetic
without an anesthesiologist where we not a
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good and safe idea.
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And an important thing about
that is that, you know,
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it varies in each individual state,
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but in New York state where
Dr. Friedman and I practice,
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there are very specific rules about
what procedures can be done in
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just an office operating room and
what has to be done in an accredited
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office operating room,
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and how much sedation
can be given if it's not
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given by an anesthesiologist
or other qualified
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anesthesia provider.
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So the idea of taking an
awful lot of oral medicine,
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which has variable absorption
really is not a safe approach.
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And if the procedure is of a
sufficient magnitude to require
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that,
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it's better to have
the quality and control
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of having an anesthesiologist who
can make sure that you're safe
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and comfortable.
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Now, let's look on the flip side.
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What are the disadvantages
of having more anesthesia?
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So of course, you know,
there's a cost to everything.
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So if you're bringing
an anesthesia provider,
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the anesthesiologist adds a
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cost medical clearance will
be required over a certain
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age.
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And people who have had anesthesia
need to go home with an escort. Again,
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in our state, New York
state, that's mandatory.
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And of course there's a little
bit of time to recover from the
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anesthesia. For minor
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procedures or a small single
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intervention, those may be unnecessary
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added impediments.
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But if you start to get to
a more extensive procedure,
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even if you do it under local,
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you're not going to be good
to drive yourself home.
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You're going to need an escort.
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You may need medical clearance if you're
older or have medical conditions just
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for the surgery to be performed safely.
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So you're not necessarily
foregoing all of those
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disadvantages just because
you're doing it under local.
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Okay. So now, Dr. Friedman, I want
to pick your brain for a moment.
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I wonder what do you feel
are the advantages of care
in the office setting and
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with the kind of ambulatory
anesthesia that is available today?
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I just want to start off saying that
today the majority of all surgeries are
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done in an ambulatory setting.
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I am not just talking about elective
cosmetic surgeries that we're discussing,
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but hernia repairs, tonsillectomies,
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knee and shoulder repairs are all
mostly done in the ambulatory setting.
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The advantages are manyfold.
I'll start off with safety.
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The risk of acquiring infections
is lower, medical error is reduced.
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The surgeon has what we'll
call home court advantage,
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having his handpicked
instruments, nursing staff,
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anesthesiologist. From
that anesthetic end,
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00:15:19,190 --> 00:15:22,160
ambulatory anesthesia has
become a specialty on its own,
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meaning that your anesthesiologist,
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who will be taking care of you in the
office setting has been trained and has
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experienced this. We have the
same medication, supplies,
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and equipment available
as in the hospital,
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and are trained to deal with any
situation that can arise. And of course,
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you have the convenience factor.
Anyone who has had to deal with hospital
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bureaucracy knows this all too well,
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your surgery starts on time
and not delayed many hours
into the afternoon while
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you are still NPO not eating
or drinking for the morning.
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The patient's responsibility for facility
costs are usually much lower than an
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alternative setting as well.
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You'll also know beforehand who
your anesthesiologist will be,
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and he or she will call you before and
go through your medical history and will
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discuss the anesthetic options
and plans. At this time,
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you would also have the opportunity to
ask any questions and then discuss any
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particular concerns that you may have.
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Finally, before we conclude Dr. Bass,
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what should our listeners take
away from today's episode?
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So I think there are a number of important
points that, that I could summarize.
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As you heard, you know,
anesthesia's very safe.
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There's a small risk, not zero,
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because there's not zero
risk in anything we do in
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life. And, and it's very
much like driving a car.
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Every time you get in the car and drive
somewhere something terrible could
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happen. You could get in an
accident, but the chance is very low.
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So you don't hide at
home in a dark corner.
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You get in the car and
drive. But you know,
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you look both ways before you
pass into an intersection.
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You follow the rules of the
road and drive cautiously.
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And even though the risk isn't zero,
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you're very safe and you get a lot of
benefit from the mobility of being able to
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drive.
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Having anesthesia allows the
procedure to be very controlled.
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It's an added layer of safety overall for
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patients.
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And working in an office-based
surgical facility is private.
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It's cost effective,
comfortable. It's very efficient.
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As Dr. Friedman just pointed out,
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it's the whole team that's
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all optimized and used
to working together.
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Dr. Friedman knows what I'm going
to do. I know what he's going to do.
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We've worked together many, many times.
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It's not whoever the
hospital sends in that day
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with a brand new team almost
every day in the facility.
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And so overall,
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this makes in office
plastic surgery the safest,
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most comfortable and
pleasant experience possible.
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For aesthetic plastic surgery. You know,
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00:18:18,870 --> 00:18:23,310
the plastic surgery experience
is about service, comfort,
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privacy,
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00:18:25,230 --> 00:18:30,030
and getting the chance to
enjoy making yourself image
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according to your
desires. It's a boutique,
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premier experience,
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the best in quality and with safety most
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important. The kind of
anesthesiologists who work in the
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office space plastic surgery
setting are committed to all of the
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principles I just listed.
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Anesthesia advances have been
central to enabling that entire
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00:18:58,320 --> 00:19:02,430
experience, even for
extensive plastic surgery.
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And it allows patients to be asleep
totally comfortable during even
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extensive procedures than wake up rapidly,
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be alert enough and comfortable
enough to walk out of the office,
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able to eat and drink and recover in
the comfort and privacy of their own
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homes.
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Dr. Friedman, would you
like to add any takeaways?
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That was a great discussion we had
today and hopefully informative to the
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00:19:29,220 --> 00:19:30,053
audience.
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Remember that your anesthesiologist is
there to keep you safe and comfortable.
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00:19:34,530 --> 00:19:36,600
Consider him your primary
care doctor for the day,
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00:19:36,840 --> 00:19:40,500
and always discuss with him or her
all of your medical conditions and any
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00:19:40,500 --> 00:19:43,890
questions or concerns you have,
and you'll have a great experience.
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00:19:44,820 --> 00:19:48,810
Thank you Dr. Friedman and Dr. Bass for
sharing your insight and expertise on
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00:19:48,820 --> 00:19:51,120
this very important
topic in plastic surgery.
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Thank you Dr. Bass for having me on
as a guest. And thank you, Doreen,
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for hosting this discussion.
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And thank you, Dr. Friedman,
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00:19:58,500 --> 00:20:01,890
for joining us and sharing
so much useful information.
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And thank you for providing such excellent
care along with the rest of your team
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00:20:07,110 --> 00:20:09,570
to my patients. I really appreciate it.
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00:20:10,350 --> 00:20:14,010
Thank you for listening to the Park
Avenue Plastic Surgery Class podcast.
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00:20:14,430 --> 00:20:16,650
Follow us on Apple
Podcasts, write a review,
327
00:20:16,680 --> 00:20:18,030
and share the show with your friends.
328
00:20:18,450 --> 00:20:21,540
Be sure to join us next time to avoid
missing all the great content that's
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00:20:21,540 --> 00:20:25,080
coming your way. If you want to
contact us with comments or questions,
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00:20:25,080 --> 00:20:25,980
we'd love to hear from you.
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00:20:26,460 --> 00:20:30,590
Send us an email at podcast@drbass.net
or DM us on Instagram
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00:20:30,960 --> 00:20:32,270
@drbassnyc.
Kalman Friedman, MD
Senior Anesthesiologist
Dr. Kalman Friedman is a senior anesthesiologist with Caliber Anesthesia in New York who has kept plastic surgery patients up and down Park Avenue safe and comfortable during their procedures. He and Dr. Bass have several years of experience working together to give patients the best results in the safest way possible.