Tummy Tuck with IV anesthesia instead of General Anesthesia

Modified on | by Dr. Ricardo L. Rodriguez

I have previously written about the types of anesthesia used in cosmetic surgery. The various types of anesthesia include local anesthesia, various types of IV sedation (where you breath on your own), and general anesthesia (assisted breathing with a tube).

I perform all of my major procedures, including multiple procedure makeovers with IV sedation with propofol. I do not use General Anesthesia which carries more risk.

The use of IV Sedation with cosmetic surgery offers several advantages over General Anesthesia:

  1. IV Sedation has less nausea than General Anesthesia
  2. quicker recovery immediately following the surgery
  3. dramatically reduces the risk of pulmonary embolism which is a major concern with General Anesthesia

To illustrate how well patients can do with IV sedation, two of my patients agreed to be filmed in their immediate post operative period in the recovery room for the purpose of this blog.

The first patient had a two hour breast procedure, and you can see that she is extremely alert after just 30 minutes out of the operating room.

Nine hour procedure performed with IV Sedation with propofol

The second patient had a multiple procedure case (Tummy tuck, Breast lift with implants,  and a Thigh lift) which involved 9 hours of operating room time. I have filmed my patient in the recovery room just 40 minutes after she was transported from the operating room. Although she is definitely sleepy, she is remarkably alert enough to recall the facts of her procedure. She is tolerating fluids.

This would NOT be the case if she had the 9 hour procedure performed under general anesthesia. I now realize that many patients I admitted to the hospital for overnight stay in the past needed to be hospitalized because of the anesthesia recovery, not because of the surgery.

It is a myth that long multiple procedure cases can not be performed under IV anesthesia. I perform 8-9 hour multiple procedure cases every week.

General Anesthesia poses more risks for surgeries longer than 4 hours

The truth is that for procedures lasting longer than 4 hours, the patient is much better off with IV anesthesia. With General Anesthesia, the risk of pulmonary embolism increases with the length of the surgery!

In IV sedation, you are using your own muscles to breathe on your own. Under general anesthesia, a ventilator blows air into your lungs, altering the dynamics of blood flow throughout your body. As the duration of general anesthesia increases, so do complications related to it. This includes pulmonary complications as well as risk of blood clot to the lungs.

To learn even more about why IV anesthesia is a better experience than General anesthesia for cosmetic surgery, see Dr. Hobelman, a board certified anesthesiologist talk about the advantages of IV sedation.

* A big thank you to my patients for allowing me to share their experiences with you!

(originally posted on June 18, 2009)

By Dr. Ricardo L. Rodriguez MD Board Certified Plastic Surgeon Cosmeticsurg Baltimore, Maryland Ricardo L. Rodriguez on American Society of Plastic Surgeons.

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7 thoughts on “Tummy Tuck with IV anesthesia instead of General Anesthesia”

  • Barry L. Friedberg, M.D. says:

    By all means, please feel free to link to the book! Happy Thanksgiving! You would make my Thanksgiving much happier with your support of this critical public health issue. No solicitation for funds will result from your signature (& maybe even some of your friends). https://www.change.org/petitions/goldilocks-anesthesia-foundation-stop-the-epidemic-of-anesthesia-over-medication

  • Barry L. Friedberg, M.D. says:

    Check out 'Getting Over Going Under, 5 things you MUST know before anesthesia.' Written for the general public in easy to understand English by the author of 'Anesthesia in Cosmetic Surgery.' Available in 3 formats, print, e-version & MP3 audio. All proceeds support the pubic education message of the non-profit Goldilocks Anesthesia Foundation. Best regards & Happy Thanksgiving...

    • Dr. Ricardo L Rodriguez says:

      DearDr. Friedberg: All of our blogreaders should know that Dr. Friedberg's book is the bible in my office, and I will not hire an anesthesiologist unless he reads parts of his book and is willing or able to justify to me why he should NOT be using Dr. Friedberg's methods. So far everybody that has tried his methods adapts to them well. If I am able to do 8 hour cases and send them home one hour after the end of the case it is because of Dr. Friedberg. More importantly, my conscience rests easier because it is safer. 4 years, 1,200 procedures later, not one single deep vein thrombosis or pulmonary embolus. Dr. Friedberg, would we be able to link to your book?

  • Jenny says:

    Great website....anesthesia (twilight or otherwise) is the domain of anesthesiologist, not nurses (CRNA's)...

    • Dr. Ricardo L Rodriguez says:

      Jenny: Although we use exclusively Board Certified anesthesiologists, we have known some outstanding CRNA's who I would trust my life with. In an outpatient surgery suite like ours, though, we feel compelled to go with MD's.

  • kim says:

    i was just wondering do all patients go into a light sleep? ive read alot of comments about twilight and even considering it myself for breast augementation but im a bit worried i am not very good with pain or needles and iv read that some patients come out of their light sleep and feel the pulling and tugging .... and i am wanting to go from an a to a d cup so my skin will be steched alot. im hoping my dr is as experienced as you sound he has alot of qualifications...anyway please write back Kim

    • Dr. Ricardo L Rodriguez says:

      Kim: I cannot vouch for the expertise or your particular anesthesiologist when it comes to twilight anesthesia. I can only speak about the work of the anesthesiologists I work with. When done correctly, Twilight anesthesia keeps you at a constant state of sedation, not the ups and down that somebody unfamiliar with the technique experiences. Believe me, there are many excellent and knowledgeable anesthesiologists who are just not good at Twilight. The use of local anesthesia nerve blocks before surgery is also very important, because it decreases the amount of pain relief you will need during surgery. The most important thing for you to do is to look at the anesthesiologist in the eye and ask him if he does a lot of Twilight anesthesia. If he/she expresses any hesitancy, let him do what he feels most comfortable with. I hope this helps!