Minimally invasive sedation anesthesia

For many patients, anesthesia is a major consideration in making a decision about surgery. The most important factors in selecting the type of anesthesia are safety and effectiveness. Although anesthesia is generally very safe, in the few instances when complications do occur in the setting of facial plastic surgery, they are usually related to general anesthesia. Fortunately, all facial surgery procedures performed in our centre are done under local anesthesia with sedation, also known as "twilight anesthesia".

Local Anesthesia With Sedation

Our PhilosophyThis is our preferred method of anesthesia. It is part of an overall minimally invasive approach Dr. Samaha has developed and fine-tuned over years.

We have been using this type of anesthesia since 2001 for all our facial plastic surgery procedures. Over 99% of patients have reported, following their surgery, that if they had to go through surgery again, they would prefer this type of sedation anesthesia (twilight anesthesia) over general anesthesia.

"Twilight anesthesia" in our centre consists of using sedating medications to induce a dream state where the patient is unaware of his/her surroundings. The medications are selected and dosed to induce light or more profound sleep, depending on the particular needs of the operation. The patient sleeps comfortably while breathing on his/her own, unaware of his/her surroundings. Once the patient is in this "twilight" state, Dr. Samaha uses a local anesthetic to numb the area to be operated, and the surgery begins.

As Dr. Samaha performs the surgery, he is continuously aware of the patient's condition. He is therefore able to control the degree of sedation or "sleepiness" by giving additional doses of medications throughout the procedure to ensure the patient's complete comfort.

This type of anesthesia has many benefits. It avoids the "invasiveness" of a general anesthetic with its associated risks and inconveniences. Because of the decreased invasiveness of this approach, there is less swelling and bruising after surgery. The coughing, nausea, and vomiting sometimes associated with general anesthesia are avoided, and the time necessary to complete the procedure is decreased. In addition, this approach imposes less "stress" on the system. All these factors contribute to a faster recovery and quicker return to daily activities.

General Anesthesia

General anesthesia is administered by making the patient completely unconscious and paralyzed. A breathing tube is placed through the patient's throat into the trachea and an anesthesia machine breathes for the patient who is monitored throughout the procedure. When the surgery is completed, the tube is removed and the patient is awakened. This type of anesthesia is more invasive option as it places more of a "stress" on the system. There is a longer period of recovery, and more nausea and vomiting after surgery. In addition, there is usually more bruising after surgery.

Dr. Samaha favors local anesthesia with sedation, as do his patients, because it is less invasive and allows for a faster recovery. However, when it is required, general anesthesia is also an available option.

Frequently Asked Questions

Am I awake during the surgery with sedation anesthesia?
No. Patients are sleeping comfortably. The main difference is that instead of having a tube in the throat and an anesthesia machine breathing for you, you are breathing comfortably on your own.

Is sedation anesthesia used widely?
Although this type of anesthesia has been used for decades, it is becoming somewhat of a lost art. Nowadays, more surgeons in North America are tending to perform surgery under general anesthesia. The reason for this is that surgical training takes place in large teaching hospitals where the overwhelming majority of procedures are performed under general anesthesia. Surgeons are therefore trained to perform surgery exclusively under general anesthesia. Additional training and experience are required to perform surgery under local anesthesia, with or without sedation, and most surgeons do not acquire this additional experience.

Which type of anesthesia is best suited for me?
Most patients are good candidates for either type of anesthesia. Rarely, a patient may be more suited for one type of anesthesia over another. Dr. Samaha takes into consideration the patient's medical condition, his/her preference and the type of procedure planned to recommend the anesthesia that best suits the patient.

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