One of the most important things when undergoing a surgical procedure, apart from the skill of the plastic surgeon, is the anaesthetic. Anaesthetists undergo an extra four years of training and residency out of medical school to become suitably qualified and gain the level of expertise required to understand exactly how anaesthetic works and the amounts required for different states of consciousness. Different amounts of anaesthetic are required for different people and different operations or procedures. Too much can kill you due to complications; too little can mean you might be awake and being able to feel pain during surgery, yet might not be able to speak or communicate this to your surgeon. Both obviously have dire outcomes and yet both have been known to happen.
With cosmetic surgery becoming increasingly popular and the regulation of the industry still catching up with the boom, many cosmetic procedures are performed in clinics or offices where although the practitioner might be experienced and qualified in the procedure they perform (don’t forget to do your research!), they don’t employ an anaesthetist to administer or monitor sedation.
We asked Dr Gavin Sandercoe, Plastic and Cosmetic Surgeon from Bella Vista NSW if he thinks there should be tougher regulations on cosmetic practitioners performing procedures in their private clinics (especially relating to anaesthesia) and if so, what things would he like to see happen. “There should be a set of standards that are applied to all doctors that are performing procedures in their rooms. So this applies to plastic surgeons, cosmetic doctors, ophthalmologists, IVF specialists and dentists, to name a few specialties that easily come to mind. I hope that the recent Medical Board / AHPRA interest in cosmetic surgery will address these issues. Any procedure that could result in an overdose of local anaesthetic or sedation due to patient discomfort should need to be performed in a facility that has the ability to convert to a safe general anaesthetic, and recover the patient appropriately.”
Simpler procedures such as a breast biopsy or minor foot or hand surgery might be suitable for lighter sedation, or conscious sedation in a clinic. However, it is becoming increasingly common for some cosmetic surgeons to perform cosmetic procedures under light anaesthetic in their clinics or offices. Herein lays the concern. The levels under which a person is placed under anaesthesia should be closely and continually monitored throughout the whole procedure. It should be tailored specifically for that person and even then there can be complications. For a practitioner or surgeon to perform these procedures without an anaesthetist present increases the risk. The other issue is when they do have an anaesthetist but might not have the appropriate equipment to manage any complications that may occur from the miscalculation of anaesthetic used. When cosmetic procedures are performed in a hospital under light sedation the risks are extremely low. Hospitals generally have at least one or more anaesthetists on hand and all the facilities required to deal with an emergency.
This is not to say that all private clinics are not fully set up to deal with emergencies. Many clinics and private surgeries are run by fully qualified and experienced surgeons who employ fully qualified and experienced anaesthesiologists. Not only this, often it is where some of the best in field are employed. Several of the best surgeons we have listed on our site practice at private clinics where they are fully set up to deal with any emergency. Dr Sandercoe says, “All hospitals need to meet the minimum criteria as set by the Australian Council of Health Standards. By not offering a general anaesthetic (and only using conscious sedation) privately operated clinics do not need to meet the same stringent standards. This allows the private clinics to minimise costs, and therefore be cheaper for the consumer. If a patient is deciding to choose to use a privately operated clinic, they should be asking if the facility is ANZCA PS09 compliant.”
If you would like more information from Dr Sandercoe on Conscious Sedation and what it involves visit his website.
If you are looking for a suitably qualified and experienced surgeon, see our directory.