How Long Is Too Long To Be Under Anesthesia?

This week’s ACA Question of the Week is a little more complex than usual, primarily because of what is involved. The question comes from our Facebook page, and asks, “I fell and ruptured one of my 30-year-old silicone implants. Since I have to have it removed, I decided to replace the implants with silicone gummy bear implants and have a breast lift and a tummy tuck. One surgeon wants to do the tummy tuck in a separate surgery because he doesn’t want his patients under anesthesia for longer than 5 hours. Another surgeon who uses nurse anesthesiologists will do both at the same time. I am 6’7”, 195 lbs. and in good health. Is it safe to be under anesthesia for 6-7 hours?”

Dr. Pane says that the biggest concern is the amount of work that needs to be done all at one time. Many surgeons won’t undertake a procedure of this length, primarily because of concerns about keeping the patient under anesthesia for too long. Under Florida law, patients who undergo procedures in a setting anywhere other than a hospital or designated surgery center cannot be kept under anesthesia for more than eight continuous hours. He also notes that he considers himself to be about “middle of the road speed” when it comes to performing extensive procedures. He says he can do the combination procedure in about five hours, and that he knows surgeons who could probably do it even faster.

Another issue is the patient’s overall health and whether they are a “bleeder.” Every person is a little different, and keeping a patient under sedation for too long may result in an unsafe level of blood loss. Presuming the patient is in good health, recovers well from surgery and does not have any abnormal bleeding or clotting problems, he sees no reason these procedures cannot be done in a single session and well under the crucial eight-hour mark to bring the patient out of anesthesia. Many surgeons would disagree with this assessment, but as with so many other things, personal preference exists among cosmetic surgeons as well.

The most urgent procedure would be to remove the leaking implant. Although surgical-grade silicone is generally not a problem within the body, the leakage can result in a bust profile that is less aesthetically pleasing than it could be, and there is always a chance that something could go wrong. As this patient wants to swap silicone for so-called “gummy bear” implants, the existing scar capsules where the current implants have been placed would need to be reworked to better accommodate the replacement prostheses. If the damaged implant wasn’t leaking, it may not take quite so high a priority on the list of concerns.

Dr. Pane’s personal preference would be to do the procedures all at one time, with an anticipated completion time of about four and a half hours to six hours as an outside estimate. He says this actually limits the trauma to the patient and makes the aftercare and recovery process much more tolerable and less painful. With regards to bleeding concerns, he observes that there are techniques surgeons can use to limit the bleeding. He has used these techniques many times and has very rarely if ever had a problem with abnormal or severe patient bleeding.

As far as having a CRNA or anesthesiologist, this is really a matter of personal preference between the patient and surgeon. Both types of providers are certified and trained in administering anesthesia, but an anesthesiologist is more common in ambulatory surgical centers or for procedures that are expected to last longer than eight hours. However, for this type of procedure, either one would have the requisite skills and competency to achieve the desired effect. Dr. Pane recommends that this patient get a couple of different opinions as to how to proceed, to ensure the best possible outcome and maximum comfort and security in the results.

If you would like to get more information about cosmetic surgery, especially if it’s specific to a particular procedure, Dr. Thomas A. Pane and the staff of Atlantic Coast Aesthetics encourage you to ask away! You can call us at (561) 422-4116, follow us on Facebook or email us at https://acplasticsurg.com. There’s a good chance your question could be the next ACA Question of the Week, to be answered by Dr. Pane in an upcoming live Google Hangout. It’s your body and your beauty. Don’t leave it to chance! Remember, the only bad question is the one you don’t ask.