Efficient Surgery

At a recent conference on rejuvenation of the aging skin, the physicians in the audience were able to respond electronically to questions posed by the conference organizers. When polled about the type of anesthesia used in facelift surgery, 2/3 of the audience responded that they used general anesthesia. Another significant percentage responded that they used conscious sedation. A relatively small percentage indicated that they used conscious sedation. When the pannelists were asked, most responded that they use  general anesthesia, commenting that it was  "more efficient"

More efficient means that it is easier and faster for the doctor, not that it is better for the patient. There is good data from Florida, where there are good records kept of adverse outcomes in outpatient surgical procedures, that procedures performed under local anesthesia are significantly safer than procedures done under general anesthesia.
Furthermore, there have been reports of celebrity facelift deaths that occurred under general anesthesia  at well respected institutions. The most prominent of these were the death of Olivia Goldsmith, the author of "The First Wives Club" in January 2004, at the Manhattan Eye, Ear and Throat Hospital, considered to be one of the best hospitals in New York City for this type of procedure.
The ultimate question is where the balance lies between patient safety and physician efficiency. It would seem that the scales should be very heavily weighted toward patient safety, but this does not appear to be the case.
Unfortunately, for the patient this quest for efficiency adds not only additional risk, but additional financial costs as well.

Gerald N. Bock MD
California Skin and Laser Center
Stockton & Lodi, CA