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Dr. Barry Eppley

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Posts Tagged ‘general anesthesia’

Protection of the Singer’s Voice during Plastic Surgery

Thursday, April 8th, 2010


Professional singers, like many artists, are also occasional plastic surgery patients for facial and body changes. In my Indianapolis plastic surgery practice, I will see about one or two such patients a year who truly do make their living by singing. In larger metropolitan areas like New York or Los Angeles, for example, vocalists as patients are in much higher numbers for sure.


While singers have the usual questions and concerns about their proposed plastic surgery procedures, they inevitably ask about being put to sleep and whether that will have any negative impact on their voice. This is a very understandable concern that undoubtably stems from the historic use of a ‘breathing tube’ for being put to sleep.


The best answer to this question comes from an anesthesiologist who ultimately is in charge of every patient’s airway during any form of surgery that requires a general anesthetic. I have asked Dr. Mark Fletcher, a board-certified anesthesiologist in Indianapolis with over 25 years of practice experience and one of the finest anesthesiologists that I know, for his thoughts on this ‘high-pitched’ question.  


‘Traditional anesthesia involves using a breathing tube that goes between the vocal cords and into the windpipe.  This is known as endotracheal intubation (ET tube) and involves inserting a plastic tube directly between the vocal cords.  After removing the tube, singers have occasionally experienced hoarseness that is temporary.  In rare cases there is the possibility that permanent changes to a patient’s voice could occur. (although this has not been reported in the medical literature)


But it is possible to have surgery today  with no risk to the delicate vocal cords. This technology is available and is known as using a Laryngeal Mask Airway or LMA.  The LMA was invented and developed by Dr. Archie Brain in England and introduced in the United States in 1988. The LMA functions like a cup inside the mouth,  keeping the airway into the lungs open but it does not pass through the vocal cords or gets anywhere near them. Instead it gently cups the opening to the voicebox from above. Not only does it protect the vocal cords from damage, the LMA is also less likely to make your throat sore. Although an LMA is not an option for every surgical procedure, it can be used for nearly all plastic surgery procedures.’


LMA anesthesia is the norm now for almost all plastic surgery procedures. There are a few facial plastic surgery exceptions, most notably rhinoplasty and facelift. In these procedures, the LMA often gets in the way or distorts the neck so it is still used during these procedures. But in all body plastic surgery, the LMA can be used for general anesthesia.


For professional singing patients, or any patient concerned about any change in their voice (even temporary), LMAs are the modern answer to these voiced concerns.


Dr. Barry Eppley

Indianapolis Indiana


Anesthesia in Surgery on Indianapolis Doc Chat Radio Show

Sunday, December 6th, 2009


On this week’s Doc Chat Radio show on WXNT 1430AM in Indianapolis from Noon to 1:00 PM on Saturday, hosted by Dr. Barry Eppley Indianapolis plastic surgeon,  the topic of Anesthesia was discussed. With guest anesthesiologist Dr. Mark Fletcher, common questions and concerns about the use of general anesthesia in surgery was discussed.

General anesthesia is usually given through a combination of intravenously given drugs and the inhalation of certain gases. Sometimes, only one is used for lighter forms of anesthesia. When you are under general anesthesia you are unconscious – and thus unaware of what is happening to you and around you. Your vital signs such as heart rate, blood pressure and heart rate are carefully monitored and controlled. You may cease breathing on your own during general anesthesia and the anesthesiologist may assume control of your breathing.

Do I have to have a breathing device?

General anesthesia often results in the loss of the ability to breathe on your own. There are different ways to assist your breathing. Sometimes this requires a breathing device to be inserted – it can go through your vocal cords into your lungs ( endotracheal tube) or is inserted only into your mouth and throat. (laryngeal mask) There are many situations when the placement of a breathing device is the safest and most reliable method to maintain a patient’s airway.

What is regional anesthesia?

Regional anesthesia refers to the process by which an injection of local anesthesia is given near your nerves and results in numbness of the area of surgery. You may remain awake or be sedated. Spinal and epidural anesthesia are the most commonly known of the regional techniques and involve injections in the back that result in numbness of the lower half of your body. There are, however, other types of regional anesthesia that can numb an arm, a single leg, etc.

Can I request the specific type of anesthesia that I want?

To some degree you can. Some operations can be performed with different types of anesthesia while some require one technique. Your anesthesiologist will review your planned surgery and your medical condition. Then they will be able to discuss your options with you and allow you to make your preferences known.

What are the common risks of anesthesia?

Luckily the common complications of anesthesia are not particularly dangerous and the dangerous complications of anesthesia are very rare. The most common complications include nausea, vomiting, sore throat, blood pressure changes, and pain. These are usually mild, not dangerous and easily treated with medication. The more serious complications include such things as allergic reactions, genetic conditions, stroke, heart attack, etc. which can lead to serious disability or death. These more serious complications are very rare. With the application of new technologies to the field of anesthesia and the use of careful monitoring, general anesthesia is extremely safe.

Free plastic surgery consultations with Dr. Barry Eppley can be arranged by calling IU Health North or IU Health West Hospitals at 317-706-4444 or sending an email inquiry to: info@eppleyplasticsurgery.com.

Anesthesia Options in Plastic Surgery

Thursday, August 13th, 2009

One of the most common questions and concerns when one decides to undergo plastic surgery is what type of anesthesia will be used. Many people have misconceptions about anesthesia. Some believe that the procedure would be ‘safer’ if one does not have a ‘general anesthetic’. Others have been put to sleep before for other surgeries and had a difficult time after surgery with nausea, vomiting or feelings of prolonged disorientation or tiredness.

Anesthesia, of some kind, is of course needed for any operation. Anesthesia provides comfort from pain and reduces or eliminates one’s awareness. Based on one’s medical history and the type of surgical procedure, your plastic surgeon may recommend local, sedation or general anesthesia.

Local anesthesia refers to injecting around the surgical site to make it numb and reduce bleeding. With good nerve blocks and local infiltration, it is amazing what can be done under just local anesthesia. Many Smartlipo procedures, for example, can be done under local anesthesia which uses a special type of infiltrating solution. However, local anesthesia is most widely used for certain types of facial procedures but its use is quite limited in larger body areas. Because its effects last around an hour or so, the procedure should be capable of being done in that time. If it takes a lot longer, it will be more comfortable to consider more significant methods of anesthesia. If a procedure can be done comfortably under a local anesthetic, costs of the procedure will be reduced because the services of  an anesthesiologist will not be needed.

Some local anesthetic procedures are made more comfortable through the use of sedation medications. Sedation is known by a host of terms such as twilight sleep or conscious sedation. Sedation causes you to become very sleepy or temporarily unconscious during the cosmetic surgery procedure. Knowing you will be unable to feel sensations or remember the surgery can induce relaxation and relieve stress.

One of the biggest advantages of sedatives is that they don’t incite the post-operative nausea and vomiting that may occur with general anesthesia. There are numerous different methods of sedation based on different drugs. It is usually a combination of a narcotic and a sedative type drug. (e.g., valium, versed) :Light types of sedation may be done by the plastic surgeon himself. Heavier sedations are best managed by an anesthesiologist, lest one end up like Michael Jackson. All sedation methods require the use of oxygen and oxygen monitoring for safety.

More invasive or extended plastic surgery procedures should be performed under general anesthesia. In this case, an anesthesiologist will always administers the drugs and manage the airway. While one may initially go to sleep with the drug now made famous by Michael Jackson (propafol), the depth of anesthesia requires a device placed in the throat so air can exchange without obstruction. This airway device (LMR or endotracheal tube) provides a method to administer gases which are usually the main method to keep you asleep. Drugs and gases will make you unconscious and unable to feel or remember anything about the surgery.

Several fears continue to exist today about general anesthesia. One of these concerns is that one may not wake up. While anything is possible in life, I have yet to ever see this happen. And putting a healthy person to sleep for an elective operation makes this risk infinitesimally remote. I tell my patients in my Indianapolis plastic surgery practice that you have a better chance of dying from an auto accident driving home from your consultation than you do from not waking up after the surgery.

Another significant concern is the fear of nausea and vomiting afterwards. In todays plastic surgery, we are very focused on that exact issue and recognize the concerns about it. As a plastic surgeon, I don’t want it either. Besides the issue of comfort, such a postoperative problem could cause a complication of bleeding and excessive bruising. For this reason, our anesthesiologists provide prophylactic measures (anti-nausea drugs) before, during, and immediately after surgery. Such an approach keeps nausea and vomiting complications quite low.

Anesthesia options in plastic surgery are controlled by the type of procedure, your medical history, and the best way for your plastic surgeon to focus on performing your operation in the best manner possible. Local and sedation anesthesia are good methods for limited procedures of short duration but can be counterproductive for most more extensive procedures. Many concerns about the risks of general anesthesia are based more on fear and misconceptions than known statistics. Todays drugs and monitoring methods have made general anesthesia safer and more comfortable than ever before.

Dr. Barry Eppley

Indianapolis, Indiana

Dr. Barry EppleyDr. Barry Eppley

Dr. Barry Eppley is an extensively trained plastic and cosmetic surgeon with more than 20 years of surgical experience. He is both a licensed physician and dentist as well as double board-certified in both Plastic and Reconstructive Surgery and Oral and Maxillofacial Surgery. This training allows him to perform the most complex surgical procedures from cosmetic changes to the face and body to craniofacial surgery. Dr. Eppley has made extensive contributions to plastic surgery starting with the development of several advanced surgical techniques. He is a revered author, lecturer and educator in the field of plastic and cosmetic surgery.

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