Eyelid surgery, or for that matter any surgery, would be too painful to perform without anaesthesia. In this blog I’ll discuss the common levels of anaesthesia offered for different types of eyelid surgery.
There are generally three levels of anaesthesia - local, sedation (twilight), and general:
- Local is similar to what most dentists will administer. It involves injecting numbing medicine at the area to be operated on.
- Sedation involves intravenous medications that alter a person's state of consciousness. Sedation will not require a breathing tube and is quicker to recover from.
- With general anaesthesia the patient is completely asleep. This technique requires a breathing tube and intensive monitoring.
Eyelid surgery can be done with any of the three types of anaesthesia. For a ‘skin only’ upper eyelid surgery, local anaesthesia is adequate. Upper eyelid and lower eyelid surgery that is more complicated, often involving more aggressive fat or muscle work, is more likely to require general anaesthesia.
What are the risks and benefits for each level of anaesthesia?
The patient’s history and tolerance are critical factors.
Local anaesthesia eliminates any pain sensation, while at the same time minimising any bleeding during surgery. However, the patient will feel the injections of the anaesthetic and there is a risk of moments of pain during surgery, which will prompt the surgeon to inject more to provide relief. Some patients (10-15%) are resistant to the effects of local anaesthetic. You have to be able to lay still to have eyelid surgery with only a local anaesthetic. If you have coped well with dental procedures then you probably will be fine with a local for eyelid surgery provided it is short procedure..
Patients who are unusually sensitive, anxious or fidgety may require sedation in addition to the local anaesthetic. This relaxes the patient and eliminates any discomfort while the local anaesthesia is being injected. Sedation makes surgery a lot more comfortable without placing a tube in your throat to help you breathe.
Some surgeons prefer general anaesthesia for eyelid surgery. Patients having eyelid surgery under local can have an increase in blood pressure if particularly nervous. This increase in blood pressure causes an increase in bleeding which clouds the operative field and makes the surgery more difficult. When having surgery with general anaesthesia you will have absolutely no pain during surgery and have no memory of the entire process. It is the most comfortable option. Nausea and vomiting may be encountered by patients but with the help of medications this is completely avoided. The anaesthetist is able to monitor you beat by beat during surgery, making it very safe. It is important that patients are screened for possible heart problems prior to surgery.
The preoperative workup of a patient for blepharoplasty is important in assessing the anesthetic and surgical risks to a patient. Patient comfort and safety should be the top priorities. With a skilled surgeon and anaesthesiologist you should be pain free, have a quick recovery and be completely safe.
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