Anesthesia

When a patient walks into Dr. Rahbans Beverly Hills office, one of the most frequently expressed concerns with regards to plastic surgery is the fear of anesthesia.

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Many patients who eventually muster the courage to undergo surgery state they ironically are not worried about the surgery itself, but rather the anesthesia. This is a very understandable concern and mostly due to misinformation. For many, this may be their first anesthesia experience, or know a loved one who had a bad experience, and hence are reluctant.

This page was designed as an educational tool pertaining to Dr. Rahban's anesthesia protocol to address these concerns, and help you feel more at ease with proceeding with surgery. As with everything that Dr. Rahban does when it pertains to his patients care, his approach to anesthesia is no less compulsive, thorough, and conservative.

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Screening and Pre-op

With Dr. Rahban, your anesthesia experience starts well before you even enter the operating room. He is very thorough and proactive in making sure you are healthy and a low risk for anesthesia complications. This is done PRIOR to surgery.

Dr. Rahban is unique with his approach in that he evaluates you as a whole, unlike many other surgeons who focus solely on their area of expertise (cosmetics). Once he completes his exam and you decide to proceed with surgery, multiple labs and studies are ordered (ie. Bloodwork, Mammogram, etc…).

If you suffer from a chronic health condition(s), does that mean you can’t have surgery? No, you simply need clearance from your specialty doctor(s) overseeing your care. Dr. Rahban will collaborate with all your doctors to best optimize your health so surgery goes smoothly. This is yet another thing that sets Dr. Rahban apart. He is less concerned about the surgery, and more interested in your overall health. If for some unlikely reason the doctors feel you are not yet optimal for surgery, then it will be postponed until a later time.

Concerns and Fears about Anesthesia - Part 1

Concerns and Fears about Anesthesia - Part 2

Importance of a Qualified Anesthesiologist

You have done your due diligence and spent countless hours researching numerous surgeons to find “the one.” The next question becomes, how many anesthesiologists have you researched? If none, then you are not alone. Most patients don’t know anything about their anesthesiologist until the day of surgery. The reality is, even most surgeons don’t know who their anesthesiologist will be until the day of surgery. While this is ok, it is less than ideal.

For the past 15+ years, Dr. Rahban has worked exclusively with the same anesthesiologists. This is by design. He has vetted them, worked with them, and knows their level of care is consistent with his high standard of care. Therefore, by selecting Dr. Rahban, you are essentially preselecting for an amazing anesthesiologist as well. This is something he discusses in more detail during your consult as he believes it should be an integral part in your decision-making process.

Dr. Rady performing surgery

First thing to understand about anesthesia is that there are many levels of providers that can be present during your surgery. Much like surgeons, anesthesiologists have a significant degree of training and skill. For example, one can have a CRNA administer anesthesia, which is essentially a nurse with extra training. While there’s nothing wrong with this as there are many good providers, in Dr. Rahbans opinion, the training is not nearly as extensive as a doctor (specializing in anesthesiology). Many patients simply don’t know that a nurse can provide anesthesia and are often surprised.

As with any area of medicine, amongst doctors there are ok ones, good ones and great ones. The question one should ask your surgeon is, who would you want to have administer anesthesia on your family?

The reality is, the better the provider, the more experience they have, and hence the more expensive it will be. When it comes to your health and safety, it’s crucial not to cut corners for both the surgeon and patient alike. The issue is that you don’t get to decide who will administer your anesthesia. It’s decided for you by your surgeon, which signifies the importance of asking at the time of your consult.

Your safety is Dr. Rahbans number 1 priority. With your best interest on the forefront, Dr. Rahban is incredibly selective with who he chooses to accompany him in the operating room. Not only are they incredibly skilled, there is a trusting friendship that has developed over the years. Dr. Rahbans anesthesiologists have taken care of his own family and closest friends. This speaks volumes of their extensive experience, resulting in hundreds and thousands of successful outcomes.

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When Dr. Rahban does a consultation with a prospective patient, he wants it to be two things above all others: thorough and honest. He will find out from you just what you want from cosmetic surgery. And he will tell you honestly if you can get the result you want, and how he can best help you do so.

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What We do to Make the Anesthesia Experience Optimal

Alongside the excitement of anticipating for this life changing surgery, it’s also normal to feel a bit anxious about the procedure you’re about to endure. Dr. Rahban understands these feelings and does everything possible alongside his anesthesiologist to make the process as seamless, and comfortable as possible for you

That being said, specific protocols are taken, combined with preventative medications to lessen the chances of experiencing these side effects:

1. Nausea

It is not uncommon for patients to experience some kind of nausea after general anesthesia. The question becomes, what precautions does your anesthesiologist take to minimize or prevent it? There are medications the anesthesiologist administers to prevent the onset of nausea symptoms through the IV such as

Reglan
Zofran
Droperidol
Decadron
Propafal
IV hydration
Scopolamine patch

AND WE GIVE THEM ALL TO YOU!

2. Pain

It is inevitable to experience pain after surgery. What patients fear is unbearable pain. Rest assured, there is no reason for that to happen in modern day medicine. Dr. Rahban is very sensitive about your pain and you will not need to convince him of that. There are many things that can be given to control the pain such as:

Nerve Blocks: Marcaine and Experal (very advanced medications used in spine and orthopedic surgery);
Prescription pain medications;
Muscle relaxers.

3. Fear of IV Placement

While this may seem silly to some patients, there are patients for whom the idea of placing the IV preop is very frightening, hence creating a lot of anxiety. Dr. Rahban is very mindful of this. His anesthesia team has extensive experience with pediatrics as well, which provides numerous techniques of placing IVs essentially pain free. One of them is the use of gas anesthesia where you deeply breath the gases to relax you while your IV is being placed. We do everything in our power to make the experience a positive one.

4. Sore Throat

It is possible to have a bit of a sore throat after surgery. This usually happens when your anesthesiologist places the breathing tube at the beginning of the surgery. Almost all do it the traditional way with a laryngoscope and their eyes. It can be rough on the throat hence creating soreness. But with the advent of the glidescope this process should be effortless and atraumatic. A glidescope uses a camera to visualize your vocal cords so the tube can accurately and smoothly be inserted with NO trauma to the tissue. Dr. Rahban strongly feels this should be the standard of care and ALL of Dr. Rahbans anesthesiologists use this instrument.

5. Intra Operative Awareness

This has become an urban legend. Modern day anesthesia is almost bullet proof and patients get multiple drugs that places them into a deep sedative state. Hence it is nearly impossible to wake up during your procedure. Perhaps with conscious sedation which is a lighter level of anesthesia, this can occur but Dr. Rahban only uses general anesthesia as this is one of the many benefits that he likes.

6. Deep/Calm Extubation

This is perhaps Dr. Rahbans most important criteria when selecting an anesthesiologist to take care of his patients. It’s the ability to extubate the patient while still in a deep sedation. When a patient is waking up from anesthesia, they go through levels of consciousness. Most less trained anesthesiologists wait until you are close to being fully awake before removing the breathing tube. They do this in order to makes sure you can control your airway and don’t have complications. However, as you enter this state you tend to awaken more agitated which raises your blood pressure amongst other things. This can compromise your outcome, increasing your risk of damaging the tissue leading to a sore throat.

Highly skilled anesthesiologists can time the removal such that you are more deeply sedated, hence in a very calm and peaceful state. Timing it just right requires extensive knowledge and few such anesthesiologists exist.

For additional information, check out the two-part series of Plastic Surgery Uncensored where Dr. Rahban and his favorite anesthesiologist have a one on one discussion on the ins and outs of anesthesia.

Closing Thoughts

We hope you now feel more at ease and educated with some of the common concerns towards the anesthesia process. In this day in age, general anesthesia is considered very safe and most patients undergo anesthesia with no serious issues. In the US alone, ASAPS reported over 18 million cosmetic procedures administered in 2019, with a very low complication rate of under 1%.

Asking your surgeon the right questions is yet another screening tool under your belt towards a successful surgery and outcome. You can be rest assured that Dr. Rahban has done his part in carefully selecting the most qualified and skilled anesthesiologists in their field. You truly are in the best of hands!