Most people will undergo anaesthesia at some point in their lives – ranging from a simple surgery on a day-stay basis through to major surgery that requires complex, rapid decisions to keep them safe. Anaesthesia is the practice of administering medications either by injection or by inhalation (breathing in) to produce a state of unconsciousness that eliminates all sensations, including feeling pain (analgesia) and other unpleasant sensations. That allows medical and surgical procedures, such as cosmetic surgery, to be undertaken without causing undue distress or discomfort. While it does carry risks, modern anaesthesia is relatively safe due to the high standards of training which put a strong emphasis on quality and safety.

 How do anaesthetics work?

Anaesthetics block the signals sent along your nerves to your brain. Nerves are the bundles of tiny fibres that use chemical and electrical signals to pass information around your body, including pain. Anaesthetics stop the nerve signals that keep you awake and aware from reaching your brain. While you (or your bundle of nerves, in the case of local anaesthesia) are in this sleep-induced state, procedures can be carried out without you feeling anything. When the anaesthetic has worn off, the nerve signals will be able to reach your brain, and consciousness and feelings will slowly return.

What types of anaesthetics are there?

Basically there are four types of anaesthetics; procedural sedation, conscious sedation, regional (local) anaesthesia, and general anaesthesia. Here’s a quick guide to the difference:

This is used when general anaesthesia is not required – sedatives allow patients to withstand the discomfort that they would experience if they were fully conscious.

Conscious sedation is a medication-induced state that reduces the patient’s level of consciousness. The patient can still respond logically to verbal commands or light stimulation by touch. The medicine wears off quickly.

Regional anaesthesia involves the injection of local anaesthetic in the vicinity of major nerve bundles linked to body areas such as the thigh, ankle, forearm, hand or shoulder. The advantage of a local anaesthetic over general anaesthetic is that there is generally less risk posed and less post-operative pain and nausea.

General anaesthesia is the most serious of all anaesthesia, as the patient is entirely unconscious. It is usually administered through an IV drip and produces a drug-induced state where the patient will not respond to any stimuli, including pain. This anaesthesia carries the most risk (albeit small) to the patient, especially if they are suffering from medical conditions or are morbidly obese.

How important is your anaesthetist?

Your anaesthetist plays as vital a role as your surgeon does throughout the surgical procedures. Some medical centres use non-certified anaesthetists or nurse anaesthetists during surgery – however, certified anaesthetists have spent years studying the medicine, and are first and foremost doctors who have a very acute knowledge of which anaesthesia is appropriate and how to manage pain. Our Consultant Anaesthetist and Critical Care, Dr Suzanna Abdul Malik, is certified by the National Specialist Register in Malaysia as a Specialist in Anaesthesiology and Critical Care, for example.

How do they decide which type of anaesthetics to use?

At Beverly Wilshire Medical Centre, the anaesthesia for each cosmetic surgery procedure that we undertake is carefully considered and recommended by our Consultant Anaesthetist and Critical Care – Dr Suzanna. They decide this based on how major the surgery will be. Other factors come into play, such as any medical conditions, if you are a heavy smoker or drinker and if you have had previous adverse reactions to anaesthesia (some people may be more sensitive to certain medicines than others). Let us give you an idea of what anaesthesia you might expect for different procedures. As eyelid surgery (blepharoplasty) is a relatively simple procedure, our anaesthetist might recommend using conscious sedation or a local anaesthetic only. This also means that you would be able to be released on the same day and undergo the surgery as a day patient. However, when it comes to more major surgery such as liposuction, a facelift or breast augmentation, these would likely be carried out under general anaesthetic. Using general anaesthetic prevents any distress to the patient that they might suffer if they were conscious, and also gives the anaesthetist and surgeon control over the body’s respiratory functions if necessary – that is particularly important for procedures which might affect the airways, such as rhinoplasty or alarplasty.

What should you expect?

1) During consultation, the anaesthetist may discuss matters including the administering of the anaesthesia or sedation, pain management, potential complications and risks. Depending on your medical history, you may be advised to stop smoking or lose weight, especially if by doing so will reduce your risk of developing complications. Use the time for your consultation wisely, as it also gives you a great chance to ask any questions you may have. 2) Patients who are undergoing anaesthetic may not be allowed to eat or drink within a specified time before their procedure. Patients who expect to be discharged from the hospital within 24 hours of their procedure should arrange for someone to escort them home. It is a requirement that such patients are accompanied by a responsible adult, who should remain with them for 24 hours. Do you have any questions for our anaesthetist?