I rarely make drastic changes in my plastic surgery practice, but deciding not to use general anesthesia is one of the happiest things I’ve ever done.

General anesthesia is when anesthesiologists induce unconsciousness by using breathable gasses to keep the patient asleep during the operation. Because the patient is unconscious and often paralyzed, a breathing tube is usually inserted down the patient’s throat to assist with their breathing for the duration of the operation.

The issue with general anesthesia is that the gases stay in a patient’s body for many days after surgery. After the procedure patients feel a lingering grogginess, lightheadedness, and nausea—that “hit by a train” feeling that patients complain about. In short, they don’t feel well.

What I’ve switched to using is called TIVA, or total intravenous anesthesia, where no breathable gasses are used. Instead the patient is given an IV with medication that puts them in an adequate state of anesthesia without requiring a breathing tube or anesthetic gases. They are essentially asleep and unarousable for the duration of the procedure, but they are breathing on their own. Since TIVA medications wear off quickly and are typically out of the patient’s body in a few hours, the patient is less likely to feel nauseous after the procedure. In fact, the IV medication used to accomplish this has an anti-nausea effect. Patients have a shorter time in the recovery room, as well as an overall smoother experience.

I noticed that with our general anesthesia patients, when we would see them the next day after surgery and take off the surgical garments, we would need to assist them to stand up, and some patients almost felt like passing out. They were extremely lightheaded. With TIVA, patients are standing up after surgery, talking, and walking around. Most people can go out to dinner the next night. It’s amazing!

There is definitely a widespread fear of general anesthesia, so patients are relieved to find out that I offer TIVA or twilight sedation procedures. It adds nothing to the cost of their procedure, I feel it’s safer, and it reduces their recovery time greatly. I’m always interested in implementing new techniques that will improve my patient’s well-being before and after surgery. Now I have found another way to make things smoother even during the procedure. I’m so glad I switched over.