twilight sedation...

What are the pros and cons and what are the comments of your surgeons??

Thanks!!!

I found these articles:

http://local.yodle.com/articles/surgery-without-anesthesia-for-cosmetic-procedures

http://www.24-7pressrelease.com/press-release/iv-sedation-allows-patients-to-remain-alert-helpful-during-surgery-116810.php

My surgeon won't use it - I don't know his reasons.

I've had both, once twilight several general.  I have a terrible reaction to general, I get very sick and a migraine headache.  With twilight, not.  I had some hand surgery under twilight and I don't remember anything.  However I'm not squeamish so I wouldn't mind being somewhat conscious.  I'm glad the doctor I'm considering uses twilight I see it as a huge plus as far as recovery and much less risky.

I have had many surgeries for my knees, foot and toes. All under general. I always woke up freexzing, crying and in great pain.

For my recent plastics, I had twilight and LOVED IT. I woke up the next day very comfortable, not fluff-brained and the only thing I didnt like was a headache, but the surgeon said it was likely from the morphine. It was gone in 2 days.

I dont know why there are the twilight nay-sayers...I would prefer that over general any day now that I have it to compare.

Soapy

I was hospitalized 3 weeks after WLS with pneumonia and pleural effusion.  I was VERY sick and had a pigtail catheter inserted in my lung for 7 days.  I SWORE that I would never go into surgery voluntarily again!  Needless to say, 1 year later, I went in for a neck/lowerfacelift

However, my anesthesiologist, upon going over my history before surgery, discussed my previous complications, and together with my PS, they decided to do my surgery with sedation.  I was a little freaked out, but he assured me that I would notice no difference during surgery between general and sedation.  He said that most surgeons prefer general because we don't move or speak, etc while under general, but there's a chance we will with sedation.  The PS just has to be a bit more patient. 

That said, my experience was wonderful!  I was talking with the staff one minute in the surgical suite, and in the recovery room the next!  No disorientation, nausea, or other side effects from anesthesia.  I just felt like I had one drink too many!  I know that it's not for all nor for every procedure, but in my case, it was a wonderful experience and well worth the peace of mind.

 Thanks guys, it's been very useful!!

Twilight is a good option for shorter procedures, may have a lower risk of blood clots because you keep some muscle activity, and has less medication side effects for many individuals.

I have done many cases under twilight, and as long as ketamine is not used (causes bizarre dreams) I have had fewer after-anesthesia med effects than with general.

The downside is that some people may have some awareness which can be disturbing, and there is limited control of your airway (i.e. no breathing tube) This is a concern when having a larger procedure like LBL where your position changes (i.e. on your tummy or side) and your face/airway can be hard to reach in a hurry.

The latter is why most anesthesiologists are concerned about doing it for larger cases.

When doing muscle repair as in TT or LBL, it is by far preferable to have the patient medically paralyzed under general...this allows much better muscle relaxation and hence easier sculpting and less abdominal pain in most cases.

I essentially allow my board-certified anesthesiologists to make the call on what is most appropriate for my patients anesthesia experience.



 

 thanks doc 

I've had both, and prefer twilight. It takes several weeks for me to really get over the anesthesia, and I always feel frightened and crappy when I come out of general anesthesia.

I like twilight, and remember little to nothing afterwards, and am able to sort of drift off in my own thoughts during it, and if the surgeon or anyone speaks to me during the procedure, I am capable of answering. I found it comforting, and less scary than general.