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Friday, March 7, 2014
Anesthesia, Twilight or General
Hello, I have a question regarding anesthesia for surgery. I underwent a small volume liposuction surgery and was promised ‘Twilight Sedation’. I was told I would feel very sleepy and that I would not remember anything about the surgery. I also was told that this was better than General Anesthesia, safer and more comfortable and without the risks associated with a General. The Doctor said I had ‘Twilight Anesthesia’ but the Anesthesiologist said I had ‘General Anesthesia’, not Twilight. A Medical friend said I had neither. What did I have? Here are the particulars. I received the following drugs through an IV: Reglan, Decadron, Glyco, Propofol, Ketamine, Mepridine and Medez (sp?) and something written as ‘LR’ throughout. Routine life support monitors were established with nasal O2, EKG, blood pressure cuff, etc. My eyes were taped shut and early in the procedure, an LMA mask was inserted. I also had local anesthesia which I was told was standard with Tumescent technique for the liposuctioning. The surgery was 2 hours and 45 minutes long and I was in recovery for about an hour. My Anesthesia report indicated ‘GA’ as this was circled in the section labeled ‘PLAN’. The other choices, ‘MAC’, ‘EPIDURAL’ and ‘SPINAL’ were not circled or otherwise noted. What kind of Anesthesia did I have? Thanks so very much.
Without a doubt you had a general anesthetic. I hope it was a satisfactory experience, despite your confusion about what was done. During a general anesthetic you are unconscious to the point of being unrousable. This is clearly indicated by the fact that you had your eyes taped shut for more than 2.5 hours, and had a large plastic device in your throat (the LMA). For the record, your anesthesiologist (if that is the kind of professional who administered your anesthesia) is a doctor too. (There are also anesthesia providers who are nurses, or Certified Nurse Anesthetists).
"Twilight sedation" is not a favored term because nobody can agree on what it means. The accepted terms are "mild sedation", "moderate sedation", "deep sedation", and "general anesthesia". The American Society of Anesthesiologists has an excellent document that covers different levels of sedation.
There is no evidence that any of the various levels of sedation are consistently safer or more comfortable than general anesthesia. Sometimes the reverse is true. What is needed is a well-trained and experienced anesthesia provider who can tailor the anesthesia to the patient's condition and to the surgical procedure. There are many variables involved in making this decision.
Gareth S Kantor, MD
Assistant Professor of Anesthesiology
School of Medicine
Case Western Reserve University