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    Old 05-18-2004, 03:08 PM   #1
    jimintucaz
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    question about risks during anesthesia

    Hi,

    I went to my primary care physician about a growth on my scalp, which he called a hemangioma, and then sent me to another doctor to remove it. This other doctor says that I need to have a "light" general anesthesia applied during the removal process, but to me it seems like a local anesthesia would be less risky and work just as well (I have friends who have had similar removals off of the scalp and only a local was used ... I even asked a friend who is a doc in another state and she said it sounded like overkill and does add more risk for me). So, my main question is should I just go get a second opinion and would it be better to go to a dermatologist? Also, the doc who wants to uses this "light" general stated to me that "there are no more risks involved for a 'light' general than would be for a local" ... is that statement true?

    Thanks for any help.

    Jim

     
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    Old 05-19-2004, 07:49 AM   #2
    surgicaldisaster
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    Smile Re: question about risks during anesthesia

    Hi Jim! I would think it might not be a bad idea to get a second opinion any time someone is going to do a procedure on ya. And not that I am a Dr. but I would think even with "light" sedation there would be an increased risk ove a local. When I was pregnant with my 2nd child I found a lump in my left breast(big). I was panicked and of course they could not do a mammogram nor did they want to use general to put me out due to the pregnancy, but the lump had to come out since they could not aspirate it with a needle biopsy. They used a local on the breast(not fun, but not that bad either!) and took the lump out while I was wide awake. All went fine and it was not cancer, but my point is if they can do that without any sedation, I would think yours should be no problem with a local either! Good luck and keep us posted o.k.? What is his reasoning for not using a local? Did he give you one? Love, Surgical Disaster

     
    Old 05-19-2004, 08:45 AM   #3
    Shoreline
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    Re: question about risks during anesthesia

    He Jim, The difference between Light anesthesia and General anesthesia is pretty significant. If you have ever had a shot of versed, of demerol and valium , that's just about as safe as light anesthesia.

    The big risk of general anesthesia is the use of paralytic agents and the use of respirtory support. With general they use a combination of paralytic, amnesiac and opiate and the anesthesiologist is responsable for keeping you breathing through a vent while your lungs are pralalyzed. The big risk is your heart stopping, which they couuld put you on a heart lung machine or the risk of your lungs not restarting on their own and being able to breath without support after the procedure because too much paralytic was used.

    But twilight or light sedation does not use a paralytic, no respitory support and they basically monitor you while in a drug induced state of unconsiousness.

    The other risk of GA or prolonged surgery is positioning. If your positioned on your belly, your head is being supported by part of the table, too much or prologned pressure to the optic nerve, pressure right above the eye can cause blindness if the anesthesiologist doesn't periodicly reposition your head. My last surgery was almost 12 mours on my face and I guess the gauze pad slipped and the tape ended up directly on my eyelid. When the removed the tape it ripped my eyelid off and had to be reatached, I woke up with a patch on and thought I was blind. You do wake a little groggy after 12 hours.LOL

    They repaired the eyelid before allowing me to awaken so it realy wasn't a big deal, Wore a patch for awhile and they removed the stiches before I had my first check on my back and no charge for the eyelid reatachment.

    But there realy is very little risk with Twilight or light sedation. If you have had benzo's and opiates in the past without any adverse reaction there really isn't anyway I can think that you would have a problem from light anesthesia. I've had GA at least a dozen times for varrious procedrures and light sedation a handful of times, the only real difference I found was the nausea caused by GA. But a GP giving you a shot of demerol in his office is probably more dangerous than an anesthesiologist giving you light sedation with all the drugs and life support equipment and experience right at his finger tips.

    Anytime your given IV drugs there is a chance of adverse reactions, but in an OR they at least have the means to manage most problems that arise. I've talked my way through light sedation never losing complete consciousness at oral surgeons, They have given me 3 times the normal dose and are afraid to give me more because they don't really have the same ability an anesthesiologist has in an OR. So you ride it out with a little versed and demi on board and the local.

    They could likely do it all with locals. But ceratin things like scraping bone are a little less unpleaseant with light sedation and head phones. I guess you could ask to use nitrous instead of IV drugs if they really think you need some form of sedation. 3-5% NO2 will make you loopy but 6-9% NO2 will put you completely out and respirtory and life support would need to be on hand if they used NO2 at that level.

    Good luck with whatever you decide.
    Dave

    Last edited by Shoreline; 05-20-2004 at 08:04 AM. Reason: Need a new Keyboard.LOL

     
    Old 05-19-2004, 03:55 PM   #4
    wirry1422
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    Re: question about risks during anesthesia

    What shore said is exactly right and i would emphasize the fact that you do NOT want to have "light" anesthesia (i always refered to this state [versed or valium only; no pancurium] as heavy sedation, but i guess the difference is semantics really) in a doctor's office, ie. a place with no respiratory support and no anesthesiologist. From what i have read the risk of death from light anesthesia (heavy sedation) causing death is one in 8.5 million in a hospital, but this shoots up 8 fold to one in 1.5 million in a doctor's office. While both stats are very remote possibilities, i still urge you to have the procedure done in the hospital's Op.Room if at all possible. In the unlikely chance something does go wrong, you'll be glad you did. good luck.

     
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