In Eye Surgery and Nose Surgery, Should You Choose Local Anesthesia or General Anesthesia?

This is Objet Plastic Surgery.

Monday has begun, with the Chuseok holiday break. Until two weeks ago, it did not really feel like autumn yet, but this morning there seems to be a cool breeze that makes autumn feel much more real.

During this holiday period, our clinic will be closed. However, on October 2, we will only see patients who have already had surgery with us. Please take note~ In this post, we have prepared information about anesthesia.

Many people tend to think lightly about anesthesia, but this process is extremely important. In any surgery, the procedure can only be performed properly if the anesthesia is done correctly. For eye surgery and nose surgery, local anesthesia? General anesthesia? Many of you may be wondering, so let’s take a look now.

Plastic Surgery

Local Anesthesia vs General Anesthesia

It is no exaggeration to say that the beginning of plastic surgery starts with anesthesia, making it a very important area.

Of course, anesthesiologists are the experts in this field. But when performing eye surgery such as double eyelid surgery—that is, when doing a relatively simple procedure—you do not need an anesthesiologist throughout the entire process. For this reason, plastic surgeons also need to have a certain level of understanding about anesthesia. That is why questions about anesthesia also appear on the board certification exam. In other words, this is a very, very important area for surgeons (not just plastic surgeons), including thoracic surgeons, neurosurgeons, and orthopedic surgeons.

Local anesthesia

This involves injecting anesthetic into only the area where the surgery will be performed while the patient remains conscious. The most commonly used anesthetics are lidocaine, bupivacaine, and Naropin. Epinephrine (which constricts blood vessels and helps reduce bleeding) is mixed into the anesthetic to perform local anesthesia. The effect may vary from person to person, but it lasts about 4 to 5 hours, after which the anesthesia wears off. Some people worry about pain after that. However, if you cut yourself with a sharp object without anesthesia, it hurts immediately, but after about 4 to 5 hours the pain becomes duller, so even when the anesthesia wears off, the pain is not that strong. In this sense, local anesthesia can also be said to play a role in reducing pain.

Sedation anesthesia

In the case of sedation anesthesia, you are briefly put to sleep so that you do not feel the pain of the needle when the anesthesia is administered.

Usually, there are three drugs: ketamine, midazolam, and propofol. All three work differently.

• Ketamine: Very effective for pain, but people with heart problems should be cautious, and it can cause nightmares. In good cases, it feels like riding a roller coaster, but in bad cases, it can lead to frightening dreams. If this drug is adjusted and mixed with midazolam, nightmares can be prevented.

• Midazolam: Used together with ketamine, it helps control pain and fear.

• Propofol: Has a calming effect on consciousness. Depending on the amount used, it can cause sedation, sleep, and even breathing difficulty. If used excessively, breathing may become difficult, so related medications must be used very carefully in small amounts.

The combination of ketamine + midazolam is often used in eye surgery. In eye surgery, blinking movements such as opening and closing the eyes are necessary, so the duration of sedation anesthesia must be very short. You sleep only for about 20 to 30 minutes, and during that time the anesthesia is given and the surgery is performed, after which you wake up.

In the case of nose surgery, because it usually takes longer than eye surgery, propofol may also be used to maintain the sedative effect.

General anesthesia

General anesthesia is different from local and sedation anesthesia. Local and sedation anesthesia use injections,

There are many other types, but in the field of plastic surgery, it does not go beyond these three. In the case of general anesthesia, breathing is used. This is called inhalation anesthesia. If you watch TV, you may see people wearing a mask and gradually falling into sleep; that is general anesthesia. Through breathing, sensation from head to toe is completely lost, and even breathing itself is no longer under the person’s own control; breathing is possible through a machine or ambu bagging by the anesthesiologist.

Anesthesia is important not only when administering it, but also when waking up.

With local or sedation anesthesia, people wake up smoothly, but general anesthesia is not like that.

So, if general anesthesia is used during nose surgery, the process of waking up is not easy, and as the face tenses up, there may be cases where nosebleeds occur and hemostasis becomes difficult. The most important thing to be careful about in nose surgery is inflammation, and what prevents this is thorough hemostasis.

If bleeding is not properly controlled, all related procedures can be undone, so at Objet Plastic Surgery, for nose surgery we often use sedation rather than general anesthesia, and even at that stage we administer anesthesia only to the level that allows the patient to follow the doctor’s instructions.

Many people say that after surgery at Objet Plastic Surgery, they have almost no bruising or swelling.

This is because, although the surgery itself may take a bit longer, we invest a great deal of time in achieving hemostasis.

■ You can also see Dr. Lee Kyung-mook’s video about the anesthesia options available during plastic surgery. Discover the know-how of Objet Plastic Surgery, where care begins with anesthesia and stays patient-centered.