Expert: Ronald Levy, M.D. - 6/4/2009

Question
My Dr will be performing a TVT bladder sling surgery in August. He's a competent surgeon, but insists on using General Anesthesia for EVERYTHING, which really upsets me greatly. Seems like total overkill.
I've read up on this surgery which is very minor and usually just done with a local anesthetic like Lidocaine. The Dr even told me it's a 15-20 minute procedure.
I'm trying to make a "deal" with him that I'll take a spinal or epidural for this (I really want the bare minimum.)
I've told him that I refuse General Anesthia whenever I can, sedation also due to being a lapband patient, and that I get very ill when I'm put under (I've had two colonoscopies w/o any sedation, just a drop of Demorol...no pain in either procedure and I was wide awake for both.) His response to me was "Don't worry, I won't talk about you while you're under" and laughed...I didn't find that funny at all.
Ten Months ago the Dr did a 5 hour surgery of "female" repairs along with a hysterectomy and partial oophorectomy (9 procedures in all.) So there can't be any possibility of him finding anything else...everything else is either gone or repaired.
How can I talk him into using the bare minimum of anesthesia? Even with Zofran, I still vomit...which could cause my lapband to slip meaning that I'd need MORE surgery, which I want to avoid at all costs.
HELP!!

Answer
If you are getting a general, that means that an anesthesiologist is giving the anesthesia. Your discussion should be with him as he decides what is the best anesthetic. If the surgeon refuses to listen to the anesthesiologist, then you might consider a different surgeon. I don't think that local would be enough for this procedure but certainly a regional would work. One thing to consider...if you have a general for such a short procedure, you will be able to be discharged within an hour. If you have a spinal, you will be stuck in Recover or day surgery for several hours waiting for the anesthetic to wear off.

Ronald Levy, MD
Professor of Anesthesiology
UTMB-Galveston