Q. Is it alright to have sedation or intercostal nerve block (ICNB) for breast surgery? (Anesthesia methods for breast surgery)

A. Yes it is. But the most secure anesthesia is the general anesthesia.



General anesthesia that we talk about in breast surgery mostly refers to inhalational anesthesia.
General anesthesia means intravenous anesthesia and,
ICNB refers to block anesthesia.

If we divide the anesthesia methods into two;

 - General anesthesia; no pain or irritation on the body
 (Anesthesia can be administered through inhalation and intravenous) 
 One loses conscious and goes blurry in this case.



 - Topical anesthesia; No pain or irritation on a particular part of your body
 (Anesthesia can be administered through topical infiltration method and blocking method)
One is conscious in this case.

We can apply any of the methods mentioned above for breast surgeries.
But the most common one is the inhalation, i.e. general anesthesia.
It is because the patient does not feel any pain, therefore the surgery procedure is secure and convenient as there is less reaction from the thorax or muscle when operating.

The sedation that we normally talk about (intravenous anesthesia), is done through propofol. The level of conscious is rather less secure compared to the inhalation types therefore, the body might move during the operation.

 
If the body moves and if the muscles contracts often, the surgery becomes difficult therefore leading to more usage of propofol. Too much usage can lead to the buildup of the anesthesia inside the blood and cause the respiratory center of the central nervous system to lose any senses, resulting in death or brain-death.

Blocking anesthesia such as ICNB cannot be used as a topical one without the drug that reacts on the central nervous system. The drug from sedation is put in with the blocking anesthesia simultaneously.




ICNB cannot be 100% reliable that it will work until the very end of the surgery therefore, one needs to add propofol or midazolam that may lead to similar outcome.



If inhalation anesthesia is used, one does not need to additionally use propofol or midazolam what remains in the body for a long time. Also, although the patient is in a deep physical decline, she will breathe through the respiratory tube therefore, she has the lowest possibility of suffering medical accidents such as death or brain-death.


Everybody wants to ‘wake up and feel nothing’ after a surgery.
When this is achieved, one can say that the most successful anesthesia / surgery has been completed.

But in order to achieve this ‘wake up and feel nothing’, one should not promote or advertise that the anesthesia is simple.

Simple anesthesia leads to more accidents in reality.

There was a known story about a middle school girl who suffered brain-death after the eye and nose cosmetic surgery. After this event, the number of advertisement about the sedation used for breast augmentation has been reduced. Breast surgery with general anesthesia and inhalation anesthesia leads to quick surgery time, and most comfortable state for the patient after the surgery to get back to her daily life.

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