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Anesthesia

Surgery: Local or General or Sedation

06/20/2007

Question:

Female age 38, heart arrthymias: no meds (see electrophsiologist for annuals) heart healthy lifestyle, sensitivity to medications and deciding what and whom should perform surgery. Removal of lipoma (diagnosis by feel). Can`t have epi and during a local, and removal of pre cancerous lesion had cardiogenic syncope (tilt table positive). Low bp, heart murmurs, autonomic nervous system,

What is least risky: Local/General/Sedation with a general or plastic surgeon? Thank you for your professional opinion.

Answer:

I cannot comment on whether a plastic or general surgeon would be the best choice.

Also, I cannot say in your particular case what is the best or safest form of anesthesia. Local anesthesia can sometimes be a very difficult experience for surgeon and patient when the surgery is more extensive than first thought. Adding sedation can help, but uncontrolled sedation is sometimes much more risky than a controlled general anesthetic.

In fact a decision between one or the other may not be necessary. You could start with local anesthesia plus mild or moderate sedation and see how it goes. At any sign of excessive discomfort or impending syncope, your anesthesiologist can change to general anesthesia. This does mean that your anesthesia provider is someone competent to assess the need for, and manage the transition.

You don't explain why you cannot receive "epi" (epinephrine I presume). If this is indeed the case, your surgery may be more difficult because epinephrine helps reduce bleeding. Other vasoconstrictors are available however. If your surgeon insists that epinephrine be used, it may be best that you receive a general anesthetic so that unpleasant side-effects that may have troubled you before, such as increased heart rate, are not experienced.

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Response by:

Gareth S Kantor, MD Gareth S Kantor, MD
Assistant Professor of Anesthesiology
School of Medicine
Case Western Reserve University