Modern Anaesthesia for Plastic Surgery

Written by Dr Julian De Silva

• Sedation anaesthesia, also known as “twilight anaesthesia,” is a combination of local anaesthesia for plastic surgery and sedative medications.
• Our patients literally sleep through their surgery, just like when you sleep at night, however brought on with medicines.
• At the centre we have developed our own specialised form of twilight anaesthesia, based on practices in the USA. This sophisticated sedation uses tiny amounts of four to five sedation medications that cumulatively give a relaxing and safe experience avoid the risks and side effects of general anaesthesia.
• In the NHS, sedation can mean having a single medication (commonly midazolam) this is limited in effectiveness; Dr De Silva’s team use a more sophisticated form of sedation.
• Our patients by definition are conscious and breathing themselves, but very relaxed and often euphoric, and typically patients do not remember the procedure.
• The recovery period is much shorter than general anaesthesia, with most patients able to leave between 30 to 60 minutes following the procedure.
• This is the most advanced sedation technique available, the highest level of safety and speed of recovery.
• Dr De Silva considers this the best option for patients undergoing nose reshaping surgery.
• All our anesthesiologists specialise in sedation, have completed thousands of cases and are trusted by Dr De Silva to sedate his friends and family.

Will I Be Awake?

Most patients feel a little anxious or excited before surgery, once sedation is started to fall asleep, and literally sleep through the surgery. You will be drowsy, relaxed and comfortable during the procedure, with no discomfort or pain. The sedative medications combined with local anaesthesia for plastic surgery ensures that you are comfortable and relaxed.

Will I Remember the Surgery?

Typically, patients do not remember the procedure or the short period of time following it, though you will feel a little euphoric. Occasionally patients can remember just before having sedation and waking up afterwards.

Is Sedation Safe?

Sedation is a very safe form of anaesthesia for plastic surgery as you are literally sleeping during the surgery. You are breathing yourself and all your protective reflexes are working normally.

The sedation could be stopped at any time and you would just wake up. Sedation anaesthesia is far less invasive than general anaesthesia.

What Are the Side Effects of Sedation?

As with any medication, the use of sedative anaesthetic agents can result in side effects. Notably, the incidence of side effects with sedation are far less than general anaesthesia: drowsiness, dizziness, shivering (4%), headaches (4%), and post-sedation nausea & vomiting (0.7%).

Anaesthesia Description

There are essentially three types of anaesthesia. The first option is local anaesthesia alone. This means that an injection of anaesthetic will be applied to the area, which will effectively numb the area and limit bleeding. Dr De Silva does not recommend this option for rhinoplasty, as this can cause patients unnecessary stress and tension throughout the procedure.

The second option is general anaesthesia. With general anaesthesia, a specialized anaesthesiologist will intravenously apply much stronger doses of anaesthesia that will put the whole body in an unconscious state. Breathing is monitored and aided with a breathing tube, and the anaesthesiologist will monitor the patient throughout the entire procedure.

The downsides of general anaesthesia include a longer recovery period of hours and there may also be some stronger side effects, such as drowsiness or nausea, making this option not suitable for all patients. It is generally unnecessary for rhinoplasty.

There are very rare and serious issues associated with general anaesthesia including thrombosis in the leg (termed DVT) or allergic reaction to inhaled anaesthesia.

The third option is sedative anaesthesia, also known as “twilight anaesthesia,” which is local anaesthesia coupled with sedative medications.

At the centre, Dr De Silva has developed a specialised form of twilight anaesthesia, based on practices in the USA. This sophisticated sedation uses tiny amounts of four to five sedation medications that cumulatively give a relaxing and safe experience to avoid the risks and side effects of general anaesthesia.

A much shorter recovery period than general anaesthesia, with most patients able to leave 30 to 60 minutes following the procedure. This is the most advanced sedation technique available, and the best option for patients considering rhinoplasty.