Propofol_ is it necessary? (IV sedation for Plastic Surgery)

There are many negative articles on the propofol these days. It has a nick name “milk injection”.

People who are addicted to propofol, hospital that black-markets the propofol, criminal activities that take place in plastic surgery clinics with the usage of propofol are some contents that are on the news. Today, I would like to share about the use of propofol that is necessary in the plastic surgery clinics.
 
What is IV sedation.....?????

I have heard that IV sedation is dangerous. Can I not do it? There are some patients who ask such question. Also there are those who ask me to put them to sleep completely so that they do not know what is going on. Let’s looks at different anesthesia methods that are used in the cosmetic surgeries.


First, local anesthesia
We do not inject the anesthesia for the whole body but for a particular part. For example if you are having an eye surgery, the anesthesia would be injected on the eyelid. This is widely used when we conduct scar / wound reduction, skin tumor removal, or such surgeries on small parts of the body.

Second, Spinal anesthesia 
This is widely used in the obstetrics. The anesthesia is injected in the spines paralyzing the lower body so that the pain cannot be felt. This is used for abdomen / thigh fat transplantation in the plastic surgery clinics.

Third, General anesthesia 
General anesthesia paralyzes central nerves therefore requires breathing tube during the surgery. Therefore, the anesthesia and intubated. One can use the ringer solution but the breathing tube is safer.

Fourth, IV(intravenous) sedation
We use the intravenous injection with sleeping drugs for anesthesia. The most representative substance used is the propofol. If there is a respiratory problem, there would be big trouble. There is no breathing tube used. therefore, one must be aware of the anesthesia usage during the surgery.



As you can see in the graph above, if you go from sleeping stage to no breathing stage, your life becomes dangerous. This is IV sedation. So if the surgery is not a major one, then is would be safe to perform the surgery during the light sleeping stage. If you think that the surgery would be too painful and you want to sleep completely then general anesthesia is recommended.
You can find many articles to well know celebrities who abuse the usage of propofol. Actually, today, one cannot discuss about the IV sedation without the propofol.

Characteristics of propofol

1. Quick and smooth
2. Long lasting effect
3. No displeasure when awake

One can easily know why propofol is sued a lot. It has a quick effect on the body, lasts long and once you are awake, you do not feel bad.

If you watch the movie, Hannibal, there is a scene where an injection is used to make a person unconscious but there is no problem with breathing. Of course, such substance does not exist today. It would take another few decades for such substance to be made. But one can say that propofol is one that is really close to this substance. Therefore it is used a lot.

There are disadvantages of propofol as well. 
1. The injection is painful
2. Too much dosage can stop breathing (Dangerous to life)
3. Anesthesia status is not stable

However good a medicine is, it can be good or bad according to the person who uses it. Drinking can kill if one drinks it too much. It can be good for the body if you drink appropriately. Propofol is similar to drinking.

There are people with misperception. Propofol is not always good for the patient. Some do not remember anything and some feel unpleasant after using it. There are those who feel good after drinking and those who do not feel good as well.

All the substances that human make act differently from one person to another. However, there is one majority opinion.

Propofol being used as a drug to feel pleasantly good is wrong. Whether you are addicted to nicotine or drug, a human being has an ability to control one self. It is dangerous to think that one can escape the reality with the help of a medication.

Propofol is perceived to be a devil’s medication but if you manage and control the
usage properly, it is something necessary and useful. Actually, all medication are like that.

Today, we looked at IV sedation and propofol.

Thank you very much.

Anesthesia for Breast augmentation

This is a frequently asked question. Today, I will answer this question through this post and also share some wrong information that some advertisements state about the breast surgery.


 
The difference about the breast augmentation and other surgeries is that breast augmentation requires a large substance to be put inside the body.
The important factor here is that, this large substance should not cause any discomfort on the body and that there should be no side effects also.
Therefore, it is very important that there is absolutely no problem while doing the breast augmentation.

Important factors to consider in breast surgery
1. The form of the breast must be stable for a long period
2. Implant should not have any influence on the original breast tissue
3. 24 hour recovery system, i.e. the patient must be able to recover within 24 hours (Quick recovery = Low possibility of side effects)
4. There should not be any bleeding or damage on the tissue
5.There should be semi-permanent stability / harmony of the implant and the breast tissue


I was really surprised at what I found on the internet about breast surgery. I found marketing statements as the ones listed below. Many of these surprised me. Here are a few.

Others apply general anesthesia, we apply local anesthesia
- When we refer to the textbooks of breast surgery, there is no recording that IV sedation has quicker recovery time than the general anesthesia
- Some might be quick to think that conscious sedation may lead to a quicker recovery, but this is not true. If you have breathing problems, or others that may danger your life, there is no way to solve these problems
-  An experienced surgeon can have the patient leave the hospital after 2 hours of the surgery although the surgeon has applied the general anesthesia
- Using conscious sedation as a marketing source to attract the patients is wrong and dangerous activity

Other hospitals cause 5cm incision but we only cause 3.5, therefore, the scar is very small
- An implant is pushed through a small hole and it needs to remain there for decades maintaining its form and shape. Size of the incision cannot be appealing marketing information
- The possibility of damage, breaking, contracting of the implant is higher than normal. For example if the implant is about 275cc and this goes through 11~12cm inlet. The small inlet might cause the implant to lose its shape inside the body.
- If a hospital wants to appeal that the incision size is 3.5cm or less, then it must also provide research data of MRI or ultrasound that an implant put through this small inlet has no problem for 10 years or more. Just using this advertising message is not appropriate for the patients in the long term.



We has our special technique that makes your breasts larger than 300cc
- This is absolutely false. The size of the implant is decided by the patient and also the size should not cause harm to the original breast size and shape. It is wrong to say that a surgeon will just make the breasts bigger.

I really hope that such marketing activities by the hospitals are avoided in the future.


Here are additional details about the anesthesia.

In plastic surgery, we use the general anesthesia that has muscle relaxant and other anesthesia so that the patient does not feel pain in the muscles. This is done through using anesthetic gas and oxygen put into the respiratory system.
Conscious sedation uses sedative, pain killers such as propofol. This does not relax the muscle so the patient may be able to move about during the surgery.

The reason why we use general anesthesia for the breast surgery is so that the breast muscle has no movement that may cause harm on the breast tissue or discomfort on the patient.

If you have conscious sedation, your muscles (i.e. pectoral muscle) might move without any intention causing tissue harm and inaccurate desquamation causing delay on recovery and bad outcome.

One must apply general anesthesia when doing the breast surgery.

Conscious sedation does not lead to quicker recovery but instead, a long one. Also, conscious sedation is more dangerous and has higher possibility of causing problems.

Anesthesia is very important to a surgery. Today we looked at various anesthesia methods and some problem associated.
Breast surgery cannot be corrected like eye/nose surgery.

 

I hope you will be able to get accurate information in deciding what is right for you. This is all for today.

Have a great day.