jphuoc

I practice anesthesia in the US, and HIV screening is not routine. The virus does not affect my anesthetic plan.

 

Exactly. Be considerate of the healthcare providers taking care of you.

Preprocedural blood tests do not include HIV screening...

 

I chose Dr. Hong at GNG for a revision rhinoplasty. He didn't talk much, but he definitely listened to my preferences. I generally prefer ENT surgeons because they also emphasize the importance of breathing function, as well as aesthetics.

 

Can you give more details? Cause I'm from the US, and I definitely did not get that vibe from GNG.

 

I chose Dr. Hong for the nose and Dr. Cho for the chin. It's still too early in my recovery to form a definitive opinion, but I like the results so far. Coming from a medical background, I do recommend the clinic based on the perioperative experience.

 

I honestly recommend you see a plastic surgeon to get evaluated. When I read "blueish color," I think inadequate blood circulation...

 

I had a revision rhinoplasty and sliding genioplasty performed at GNG in November, and I can assure you I was never offered a discount to write reviews. I would have been flooding this forum nonstop if that were the case haha.

 

Both. Exercise increases blood pressure, so the hydrostatic pressure in your blood vessels overcome the pressures in your tissues. Fluid leaves the vessels and collects in the tissues causing swelling. Salt has a similar effect since sodium causes water retention, also leading to an increase in the hydrostatic pressure of your blood vessels. Hope that makes sense.

 

American Society of Anesthesiologists recommends at least 2 hours for water/clear liquids and 8 hours for meals, excluding patients with uncontrolled diabetes who have delayed gastric emptying. But I mean, of course play it safe and follow clinic recommendations. 12 hours without water is overkill in my opinion. Most anesthetics cause a decrease in blood pressure... and being severely dehydrated definitely does not help.

I am not familiar with anesthesia practice in South Korea. I have never seen a rhinoplasty performed under conscious sedation, but it depends on the depth of anesthesia used. If the surgeon relies primarily on injections of local anesthesia at the surgical site, and you are kept relatively awake, there will be a lower risk of aspirating blood or stomach contents into your lungs since your body is “awake enough” to protect itself. However, the greater the depth of anesthesia, the higher the risk of aspiration without an endotracheal tube secured in your airway.

 

I know this was directed to MissOrange, but I thought I would give some input. My biggest advice? Be honest. Notify the clinic of any preexisting health conditions and all medications you are taking, including herbal supplements. In the US, young, healthy adults generally do not undergo extensive workups prior to outpatient surgery. Even an ECG is usually not obtained for a 20-something year old with no significant medical history.

Here's some questions that a standard evaluation should include:

Do you have any drug allergies? Have you had GA before? Have you or any family members ever experienced problems with GA, such as fever or death? Do you have a history of seizures or stroke? Any lung conditions, such as asthma or shortness of breath? Do you smoke? Do you drink? Any recreational drug use? Any cardiac conditions such as high blood pressure or an abnormal heart rhythm? Are you able to climb at least 2 flights of stairs without stopping? Any stomach issues, such as acid reflux when you lay flat? Thyroid problems? Diabetes? Have you noticed any easy bleeding or bruising?

Just some questions to think about.

And PLEASE, for the love of God, no food 8 hours prior to surgery, no water 2 hours prior to surgery.

 

Thank you lemontea for correcting that statement. MissOrange gave a perfect example of an asymptomatic cardiac condition that can prove fatal: hypertrophic obstructive cardiomyopathy.

More truth. Cost effectiveness is always factored into patient care. OF COURSE all medical practitioners wish they had a 12-lead electrocardiogram, metabolic panel, blood count, coagulation panel... an echocardiogram, a stress test, and a pulmonary function test would be amazing too.

BUT that's over doing it for standard outpatient procedures on young healthy adults because who's going to end up paying for it? The patient. And guess what? The patient will soon be calling a few months later complaining of all the extra costs.

EDIT -- These outpatient surgery centers will always exist if there is a demand from the public. So everyone please understand that although general anesthesia is performed routinely, it does have associated risks.

"The medications we give you can cause possible memory problems, organ problems, and in the most severe cases, death. The breathing device we place in your mouth can cause possible damage to your lips, your teeth, your mouth, and your throat, and possibly your eyes."

 

All septoplasties and rhinoplasties should be done under GA for the reason you mentioned. However, an LMA is not considered a protected airway. If there is an increased risk for aspiration, an endotracheal tube should be used.

In the US, coagulation panels are not routinely sent for outpatient procedures.

Truth.

Extensive lab work and physical evaluations are not performed on young patients with no prior medical history even at the most renowned medical centers. This unfortunate incident should highlight the risks we all are accepting when having procedures done at an outpatient center. Outpatient centers are not equipped like major hospitals, and the staff are not as prepared to handle emergent events.