General Anesthesia versus Twilight Sedation

Hi Bonnie,

I do feel that doing twilight well takes experience.  There is nothing that makes it inherently unsafe.

As far as safety and medical tourism is concerned, I am 100% supportive of any patient who travels for surgery provided that:

1) The facility used is accredited by Joint Commission International http://www.jointcommissioninternational.org/about-jci/

2) Followup care and complication management is rendered or supervised by the operating surgeon

3) Blood clot prevention is done according to standard protocols

I can't say that I have an opinion one way or the other on paid drivers in terms of patient safety.

 Here is an interesting video blog to watch regarding twilight sedation:

http://www.cosmeticsurg.net/blog/2009/06/18/cosmetic-surgery-anesthesia-iv-anesthesia-twilight-is-great/

 In reading some of the comments from the video blog, this surgeon does say "Believe me, there are many excellent and knowledgeable anesthesiologists who are just not good at Twilight."  This seems to be in line with what Dr. L says.  It seems you would want to go with someone who has a lot of experience with twilight.  

 Hello everyone. Thank you for all of the responses! I had no idea this was a hot topic of sorts. I've really just started all my research and this is one question of many I need to figure out in making my decision. I had many Dr's question my decision to go with my WLS in Mexico, with Dr Ungson, but honestly, I don't think I would have had any better experience in the US, so in that instance travelling was the right decision. I am particularly interested in the twilight sedation - specifically, whether or not people are waking up during surgery and/ or conscious enough to feel or know what's going on but are not coherent enough to do anything about it - request help from the surgeon. Have people heard of this? Not sure if I'm being completely paranoid.

I had surgery using twilight sedation and I "woke up" twice during the procedure. I felt no pain as I was also administered an epidural. I did feel the doctor working on my body, but no pain. I just made eye contact with the anesthesiologist to make her aware that I was awake and then I was out again.  

Well, here is my opinion based on 10 years of experience with weight loss patients, hundreds of cases, some well-accepted practice guidelines, and a few studies:

Twlight may allow you to wake up with less "hangover"  and less pain

"Fifteen unintended admissions occurred secondary to nausea, prolonged drowsiness, or pain control needs"
http://www.ncbi.nlm.nih.gov/pubmed/10513915

Twlight results in better muscle tone and less blood clot risk

Twlight is NOT a nausea-free experience based on numerous research studies
The propofol infusion group experienced significantly more nausea in the recovery room (p = 0.002), nausea at the time of discharge (p = 0.009), and nausea the evening after the operation (p = 0.013).
http://www.ncbi.nlm.nih.gov/pubmed/14578803

Twlight can result in recall of "unpleasant events" during surgery

The midazolam/fentanyl sedation group had more recall of "unpleasant intraoperative events" (17 percent versus 3 percent, p = 0.007). However, both groups had low recall of intraoperative pain, anxiety, and nausea.
http://www.ncbi.nlm.nih.gov/pubmed/14578803

90% of patients in one study said they would prefer twlight sedation over general anesthesia.

Twlight anesthesia at my facility is absolutely prohibited for cases over 2 hours and can never be used during  a procedure where the patient lies prone (face down i.e. for LBL or back, buttock, or hip liposuction) due to concerns about being able to contriol the airway and breathing.

Additionally, we are prohibited from using more than a certain amount of numbing medicine due to heart and seizure complications.

In summary, I would again say that any anesthesia type that is performed at a facility accredited and regularly inspected by an agency you can independently verfiy is safer than one you cannot verfiy.  Same goes for any doctor to whom you will entrust your care.



 

Thanks DrL
For what it's worth, I had a good experience with twilight anesthesia during a D&C I had to have a few years ago (obviously a short procedure).  Based on that, I have asked 5 different plastic surgeons about using it for a tummy tuck and/or LBL, and they all said they would not even consider it.

I know this is an old thread but it is usually a requirement that the patient have a designated care given for 24 hours prior to leaving their surgery center for that exact reason. I work at a surgery center and that is part of our discharge requirements. The designated care giver is told they must remain with the patient for a minimum of 24 hours and we have the caregiver sign the patients discharge instructions and teachings. 

Wow this thread is amazing....  I also had plastics with twilight and felt nothing and did not wake up during the procedure.  I felt so much better and recovered much faster than with general. 

I just found out a friend of a friend died 2 days ago after a face lift with general.  I think they send people home way too early after procedures here in the states.  This lady was released from the clinic and died on her couch that night when her son left to pick up her prescriptions.  I stayed in the hospital for 6 days after my plastics and then another week at the local hotel before returning home.  I cannot imagine how people here in the states fend for themselves 24 hours after major surgery and are just sent home.  I guess that is why our malpractice/legal system works so well here???