Anesthia, IV sedation, and Anesthesiologists

[aone]

Hi! I know that when undergoing surgery, it's a big point for an anesthesiologist to be present during the whole surgery. I contacted a clinic I was really interested in going to. The doctor left his previous clinic and opened his own. When I asked if there was going to be an anesthesiologist present, he said that I was going to be under IV sedation, so there was no need for an anesthesiologist. IV sedation is when you're drowsy, sleepy, but still awake. You may not be able to move or feel anything, but you can hear the things around you and communicate, though you may not have any memory of what you said. Think about wisdom teeth at the dentist, and the silly videos you may have seen on YouTube where people said funny things. It sounds fair enough that because the anaesthetic administered isn't enough to knock you out therefore isn't enough to seriously harm you, an anesthesiologist may not be needed if the person administering the drug knows what they're doing. But I've seen terrible stories of deaths and they terrify me, to say the least. I don't want to end up a brain-dead patient.

What are your thoughts?

[minnie]

I have the same worries! I prefer smaller local clinics but most of these don't have an anesthesiologist. I don't know what surgery you are doing, but the majority of cases of eye and nose surgery in korea are done under twilight anesthesia, not general anesthesia (unlike US and europe). You absolutely need an anesthesiologist for GA!! 

For sedation, I'm unsure... I heard that even if they have an in house anesthesiologist they only do GA and the sedation is done by either a nurse or the surgeon themselves. So it might not even make a difference. On the other hand they would at least have an anesthesiologist available if there should be any complications. If heard stories of people waking up from sedation because it was too weak. 

Many of the clinics who have results I like don't have an anesthesiologist and only do sedation... I feel like it should be safe given how common it is, but as someone with little medical knowledge it's hard to say.

[aone]

Ah. Thanks for your input! I'm for sure doing rhinoplasty and DES. Maybe fat graft if the doctor recommends it will help get the look I want. What are you getting done?

Tbh your post put me more at ease since its so common for smaller clinics to not have an anesthesiologist and emergency cases are slim compared to the successful cases. Not undermining the presence of an anesthesiologist, of course. 

Edited July 17, 2020 by aone

[lorelei]

I'm glad you asked this because I also had some smaller clinics tell me they would use IV Sedation and I was like huh? Because I had only ever see posts about general anesthesia. 

I poked around the internet (most Real Self q&a area) and it seems that, at least in the US, surgeons prefer GA because it completely knocks out the patient so the patient can't move. With sedation, the patient is technically still awake, although out of it, but if they suddenly snap back to and panic, they can move around and that can be dangerous. 

For GA, it seems a big reason that you need a dedicated anesthesiologist is because, as said before, GA completely knocks you out. This includes your ability to breathe, so with GA you have to be intubated/have a "protected airway." Under sedation, you're still able to breathe under your own power. Since the nurses and doctors will be focused on your surgery, you probably wouldn't want them also distracted by watching breathing monitors and such as well. In addition, an anesthesiologist is trained to identify if you have an allergy and can correct it on the fly. 

You can ask the clinic if they have an in-house anesthesiologist, even if they are smaller or don't have one listed on their website. For example, I asked Dr Jin from Premium Nose if he has an in-house anesthesiologist and he told me they have a full time anesthesiologist on standby (meaning the person does anesthesia full time, but isn't employed only by their clinic). Even with IV Sedation, you can ask your doctor who will be administering it. 

Another point, I think that most of the smaller clinics probably use IV Sedation because I imagine that anesthesiologists are expensive (both in house and full time on standby). I'm can't say for sure about Korea, but I have a couple friends that are anesthesiologists in America. One is a doctor and one is a nurse. They get paid A LOT more than their not anesthesia trained counterparts, BUT they also had to do a lot more schooling and training as well. The anesthesia programs are very competitive to get into as well and you have to be kinda a top doctor or nurse to get in (from what they've told me). Also, in case this adds an additional question: is a doctor or a nurse better? For plastic surgeries, either is fine. My doctor friend said the main difference is that the doctor version is trained to do more complex causes on the fly, for example accident victims that need immediate surgery in an ER situation. Also doctors can do research. Neither of these situations apply to surgeries we would be undergoing.