Sedation and safety in cosmetic surgery

What does twilight anesthesia mean?

What people commonly call twilight anesthesia usually refers to sedation, in which medication is given through a vein to ease tension and pain. A 2010 literature review of anesthesia in plastic surgery covered the basic principles of conscious sedation and deep sedation, effective local anesthesia, surgery performed while the patient is awake, and monitored anesthesia care (MAC) ^[1].

As sedation becomes deeper, the ability to breathe on your own and keep your airway open can decrease, so the monitoring and preparation needed differ with the depth of sedation. That is why the level of sedation planned, and who will monitor you and how, are important parts of safety.

Features of office-based anesthesia

As more surgery is performed in office-based settings rather than operating rooms, office-based anesthesia has become a rapidly growing field ^[2]. A 2012 literature review saw demand for cosmetic surgery as one of the main drivers of that growth, and explained that anesthesia for cosmetic surgery in these settings is often provided as monitored anesthesia care ^[2].

The same review pointed out that the office-based setting has many advantages, but that patient safety can be put at risk if its limitations are not recognized and prepared for ^[2]. A 2013 literature review of cosmetic facial surgery also described office-based anesthesia as generally very safe, while stressing that no anesthesia or sedation given outside an operating room should be regarded as minor ^[3].

Conditions that improve safety

A 2019 literature review noted that with appropriate patient selection and adequate safety protocols, some procedures can be performed with a very low rate of complications even in an office-based setting ^[4]. Current regulations focus on reducing surgical risk through patient safety protocols and standardized care ^[4].

The 2013 review took the view that systematic preparation and patient selection, close cooperation with the operating surgeon, and skilled anesthesia care improve patient safety and satisfaction ^[3].

• Emergency response guidelines and supporting tools
• Surgical safety checklists
• Facility accreditation standards
• Medication management and reduction of surgical risk
• Appropriate patient selection

Care after surgery

Anesthesia safety continues after the surgery is over. The 2010 review covered postoperative pain control and the assessment and management of postoperative nausea and vomiting as important parts of anesthesia care ^[1].

The 2012 review of office-based anesthesia for cosmetic surgery also stressed the importance of measures to prevent venous thromboembolism ^[2]. Blood clots that form in the veins of the legs can cause problems, so the prevention method is decided according to the type of surgery and your individual level of risk.

Information you must share before surgery

On December 14, 2016, the US Food and Drug Administration issued a warning that repeated or lengthy use of general anesthetics and sedatives in children under 3 years of age or in pregnant women during the last 3 months of pregnancy may affect children's brain development ^[5]. It recommended weighing the benefits and risks especially for procedures that may last longer than 3 hours or when multiple procedures are needed ^[5]. If you are pregnant or could be pregnant, you must tell your medical team in advance.

Other information needed to plan your anesthesia includes any medical conditions you have, the medications you take, and any discomfort or unusual reactions you had with previous anesthesia. Responses to anesthesia differ from person to person, so the method that suits your condition should be decided through an examination and consultation.

What to check during your consultation

Twilight anesthesia may seem short and simple, but having the right safety conditions in place matters more than anything. It helps to check the following before surgery.

• The planned anesthesia method and depth of sedation
• The medical staff and monitoring equipment that will watch your condition during anesthesia
• The procedures and equipment in place for emergencies
• The plan for managing pain and nausea and preventing blood clots after surgery
• Instructions on fasting before surgery and how you will get home