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Anesthesiology/MAC with Versed versus General Anesthesia

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Question
I ma having one eyebrow lifted because of facial paralysis. It will be a direct brow lift.  The Dr office surgical personnel say I have to have MAC.  But, I want deeper sleep.  Two years ago I had the gold weight that is implanted in my eyelid (again because of the paralysis) was coming out. By the time I was able to have the surgery to remove it, it was almost out.  I was given Versed.  The Dr said it only took a couple of minutes to remove it and stitch it back up. The problem is that it HURT and I was not able to convey to the Dr that it hurt.  I know Versed is supposed to erase your memory, but it didn't.  So, when they put the weight back in a few months later I was given General Anesthesia because I was so nervous. I was also not given Versed per my request. What can I request to make sure I stay out and have no pain.  I do NOT want to be awake at all.  When I talked to the anesthesiologist before the second surgery I asked about propofal but was told they didn't use it at the Surgery Center where I will be going. Even with the GA for the last surgery I woke with a sore back because I was SO tense about the pain. The Anesthesiologist told the nurse it was even hard to insert the breathing tube. The Dr office worker doesn't seem to understand and I am not sure how to proceed.  Any ideas of what to ask for would be greatly appreciated.

Answer
There are several issues here that need to be addressed. The Versed is for anxiolysis (reduced anxiety) but does nothing for pain. For that they should have given you more local anesthesia. If you are only getting sedation, there is no reason you can't tell the doctor that it is hurting so I don't understand why you couldn't convey that. You then state that the anesthesiologist said they don't use Propofol. Are you sure you were talking to the anesthesiologist and not the surgeon's nurse? Nurses are allowed to give Versed, etc. but only an anesthesiologist can give Propofol. I find it unusual that an anesthesiologist would say that to you. Normally I would tell you to just tell the anesthesiologist (if there is one) to just do a general anesthetic but you also state that they told you that you were a difficult intubation. This changes the picture completely. If you are, in fact, a difficult intubation, then avoiding general anesthesia is a better option. If they do have to do general anesthesia, then they would need to do an awake fiberoptic intubation (which is safe but not very pleasant for the patient).

So here is what I recommend. First make sure that you have an MD anesthesiologist (or at least a CRNA) to provide your anesthetic. Then you need to find out if you truly were a difficult intubation on your previous visit. If yes, then I would recommend sedation with Versed and a little Propofol but with good local anesthesia. If you are not a difficult intubation, then request a general anesthetic.

Ronald Levy, MD
Professor of Anesthesiology
UTMB-Galveston

Anesthesiology

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Ronald Levy, M.D.

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Associate Professor of Anesthesiology, University of Texas Medical Branch at Galveston. I am a board certified anesthesiologist who can answer all questions related to any type of Anesthesia with the exception of Pain Management.

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