Utilizing officially certified operating facilities

With most plastic surgery procedures, you won’t spend time in the hospital. In fact, your surgery will likely be performed on an outpatient basis in an outpatient or ambulatory surgery facility. The surgery center or surgery suite may be part of your surgeon's office or in a separate location. Some very minor procedures, requiring only local anesthesia, are performed in a medical office setting. There are also cases where surgery takes place in a hospital OR (operating room), for instance: if you’re having multiple procedures, if your surgery is reconstructive in nature and is covered by insurance or if your surgeon feels that your health condition requires it.

Is Your Surgery Center is Safe? Here's What to Look For

 

Today’s modern surgery centers are generally well equipped to handle most cosmetic surgeries, including any type of anesthesia required. Outpatient surgery facilities also help patients save money by avoiding the hospital -- but you can’t assume all centers are safe. You must look for hallmarks of quality, just like you do when choosing your plastic surgeon. In that case, you look for medical Board Certification, state licensure, surgical privileges at a well-known local hospital and more. (Think of surgical hospital privileges as extra vetting of your surgeon's qualifications, even if surgery will not take place in the hospital. Good hospitals only grant privileges to surgeons who meet their performance standards.) 

The only way to know for certain if your surgeons’ preferred outpatient surgery center, ambulatory surgical center or office-based surgery suite is well-equipped and adheres to the highest safety standards is to look for accreditation. You can ask your surgeon if their chosen surgery facility is accredited and by which organization or go to the center's website. You should also verify the accreditation information with your state.

What Does Surgery Center Accreditation Really Mean?

 

Accreditation requirements vary by state and only certain accrediting organizations are accepted. Surgical center certification organizations all have slightly different standards. Normally, accreditation indicates that the outpatient surgical center has an excellent safety record. Most accreditors for surgery facilities require inspection and recertification annually--and require that any adverse incidents occurring in a surgery center be reported, so that they can accurately assess quality. To learn the exact accreditation requirements, check the accrediting organization's website for a list or contact the accrediting organization directly.

Advantages and Safety of Total Intravenous Anesthesia (TIVA) for outpatient procedures.

For anyone planning elective plastic surgery, one of the biggest decisions involves the type of anesthesia that will be used. Depending upon which cosmetic procedure is being planned, the plastic surgeon will make a recommendation about anesthesia, based upon the length of the surgical procedure, patient's overall health, which body part is involved, and his or her preference and experience. General anesthesia is often recommended for outpatient cosmetic surgery.

What is TIVA?

 

TIVA is a type of general anesthesia, which uses IV (intravenous) anesthetic drugs only. This means that TIVA (Total Intravenous Anesthesia) involves placing a needle into a vein, typically in the back of the patient's hand. Throughout the surgery, the needle continually injects just the right dosage of medication(s) required to keep the patient asleep and pain-free.

When TIVA is used, the dosage of anesthetic medication is computer-controlled (with target-controlled infusion or TCI), adjusted and monitored throughout the surgery to maintain the utmost level of patient safety. The computer doesn’t act alone however. TIVA patients can rest assured that their trusted medical team, including an anesthesiologist or nurse anesthetist, is also monitoring their vital signs and welfare during the surgical procedure.

What Other Types of Anesthesia Exist?

 

TIVA is a more precise alternative to other general anesthesia methods. Other methods deliver anesthetic medications via inhalation or using a combination approach of inhaled drugs and IV anesthetics. In these cases, an anesthesiologist or nurse anesthetist monitors the patient and makes adjustments during surgery.  

When general anesthesia is not needed, lesser methods like IV sedation can be used, when the patient is not completely unconscious. (However, patients are unaware and pain-free during surgery. Under IV sedation, patients cannot generally remember what happened during surgery, or immediately before and after, once the medication wears off.) 

Local anesthesia, used for minor procedures, numbs the operative region only via a single injection, which may be repeated if necessary during treatment, while the patient remains awake and aware throughout. 

TIVA Advantages in Outpatient Plastic Surgery

 

Although general anesthesia of any type is considered safe when administered by a certified and experienced medical professional, TIVA can offer distinct advantages for the patient, including: 

• Precise control of medications and dosage for a safe and painless procedure.
• Less chance of post-op nausea. Nausea after inhaled or combination general anesthesia is very common and often stems from the patient receiving too much medication during surgery. Nausea is rare after TIVA because precision computer control of the medication throughout the entire surgery ensures the patient receives just the right dosage every second of surgery. Proper, optimised anesthetic dosages are given with TIVA's computerized delivery system.
• Avoids sore throat, hoarseness and vocal cord irritation from inhaled general anesthesia.
• Quicker wakeup after surgery, which can mean less grogginess for a shorter time and less expense. 
• Possibly less expense. TIVA often means less time in the recovery room, as mentioned. In some cases, patients experiencing severe side effects from inhaled or combo, non-TIVA, general anesthesia end up in hospital overnight. This is expansive, uncomfortable and may add risk--exposing patients needlessly to hospital infections.

Patients considering elective plastic surgeries, such as a facelift with blepharoplasty (eyelid surgery), breast augmentation, lifting or reduction, rhinoplasty (nasal surgery or nose job), etc., should ask their surgeon about TIVA. Taking an active role in planning surgery, including selecting an experienced surgeon and making informed anesthesia choices, helps ensure your comfort, wellbeing and a successful surgical outcome. 

Important: All general anesthesia carries risk and TIVA may not be appropriate in every case for every patient. Be sure to consult a well-qualified and experienced plastic surgeon.