The Great Fear of Anesthesia

Many of the patients who consult with me relay their fear of anesthesia for elective procedures. Usually their fears are without merit or at the very least, blown out of proportion. However, in light of Michael Jackson’s death and all the talk about Propofol, a powerful drug that is sometimes administered to a patient to place them under deep sedation for surgery, several people I have spoken to expressed their newfound fear of "going under". In my experience, since cosmetic plastic surgery is done only on healthy people who have gone through a series of pre-operative medical tests, complications from anesthesia are very infrequent.

In my opinion, the only patients who are at a greater risk are those who are in a poor or weakened health condition, extremely overweight, suffer from high blood pressure, liver or kidney problems, complications stemming from diabetes, or various other life-threatening diseases or possible addictions to drugs. That category of patient is soon eliminated as a health risk for having cosmetic surgery, so the patients we do perform cosmetic surgery on represents the healthiest and most select group of patients who are unlikely to have any medical difficulties. Obviously, the key to achieving the optimum result in any surgery is seeking out the most qualified, respected surgeon and anesthesia specialist utilizing the most advanced and accredited operating room environment.

The anesthesia used today is very advanced and a far cry from early variations. The onset of computerized monitoring where the vitals such as blood pressure, pulse, oxygen and carbon dioxide levels are automatically checked by extremely accurate sensors are now the norm, and the anesthesia specialist, an MD-anesthesiologist or Certified Registered Nurse Anesthetist, has a good idea of how the patient is functioning while they are under anesthesia. In addition, today we have many anesthetic medications which provide the safest and most controllable situations under anesthesia. In Michael Jackson’s case, as we glean more information every day, it appears that he was administered Propofol by a physician who had no expertise in the field of anesthesiology, nor was Mr. Jackson given this strong medication in a properly controlled setting. I always explain to fearful patients that I only work with the finest, accredited surgical centers and the most experienced professional anesthesia specialists and in my many years of experience, the risks from anesthesia are minuscule.

It is also interesting to note that I have had several patients inform me that they were surprised to find out that during the operation they were not unconscious and in some instances, even had full conversations with the anesthesiologist, doctor and nurses, but had no recollection of feeling pain or having participated in the conversations! Obviously, some anesthetics are not appropriate for all procedures, but it certainly shows the triumphs of today’s advanced anesthesia.

It is always a good idea to be knowledgeable of any situation before diving uninformed into something headfirst, and preparing for surgery is no exception, but here’s some comforting news for you: if you do plan to have surgery (and it should always be in an accredited operating room, hospital, outpatient surgery center or doctor’s office with a trained anesthesia specialist in attendance), chances are you would encounter far more risk driving in your automobile to the surgery!

— Robert Kotler, MD, FACS