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The Twilight Sedation Saga



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Is ‘Conscious Sedation’ Life-Threatening?

So what is the difference between local, general, IV and twilight sedation? And how do we know that we are in safe hands? At PHI Clinic we believe in informing patients as much as possible, to ensure patients come to an educated and conscious decision.

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General Anaesthetic

Possibly the best known form of sedation is general anaesthesia. It is a state of controlled unconsciousness, which prevents pain during the procedure and blanks out the memory of the surgery afterwards. In some cases, depending on the type and scale of the surgery, general anaesthetic remains to be the best form of anaesthesia. This is usually the case for longer procedures, such as tummy tucks, thigh lifts and breast augmentation.

Local Anaesthetic

As the name suggests, local anaesthesia is where the treated area is completely numbed, but the patient remains awake throughout the procedure. The mechanisms of all forms of anaesthesia have yet to be exacted, but it is believed that it stops the nerve endings from sending messages to the brain, which usually registers pain and sensation. The sensation will come back usually after a few hours after application. This is used in smaller operative cases, but there is precedence of it being used for slightly more invasive procedures.

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Topical Anaesthetic

A milder version of local anaesthetic, topical can be bought over-the-counter in pharmacies, and is used for smaller procedures, such as tattoo removal and non-surgical laser treatments. It is also found in small doses in creams, ointments and gels for pain relief, for example, if you have a mouth ulcer.

IV Sedation, Twilight Sedation & ‘Conscious Sedation’

Twilight sedation is frequently referred to as ‘conscious sedation’, and is a mixture of IV and local sedation. The patient is not given any paralysing agents and they are able to breathe independently. It is designed to put patients in a ‘twilight state’, without making them unconscious. Twilight sedation reduces the risks of nausea and drowsiness after the procedure, speeding up recovery time.

Intravenous Conscious sedation, or IV sedation, is a drug introduced through the bloodstream to dull the senses to the surgery. This form of sedation does not put the patient to sleep, meaning they are able to respond to requests from the surgeon, but they will not have a clear memory of the operation afterwards, if at all. As IV sedation does not block the pain itself, it is often used in conjunction with local anaesthetic to make the experience as pleasurable for the patient as possible.

The Australian Society of Plastic Surgeons have warned the public of the potential risks of twilight sedation, also referred to as ‘conscious sedation’, in unregulated practices. This is in response to the rise in patient deaths, and complications related to anaesthesia and sedation during surgery. In the right hands, this form of sedation is perfectly safe, but in an unregulated industry it can be potentially harmful. Frequently consumers are unaware of the various implications, risks and processes in place relating to sedation.

What appears to be a heightening concern, which was indeed raised by the news in Australia, is that surgeons are operating and sedating themselves, without additional staff and anaesthetists. This means they are distracted from the surgery, and cannot monitor the levels and doses of anaesthetic given. In the UK, it is a CQC requirement that IV sedation is administered and monitored by an anaesthetist with specialised training. It is extremely important to go to a CQC registered practice which has an anaesthetist on board, as well as the surgeon, for this reason.

 

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Cosmetic Industry Regulations

Although this story has stemmed from malpractice in Australia, it is important to understand the UK’s principles for cosmetic procedures, and the system in place for surgery.

The UK’s cosmetic sector is largely unregulated, meaning those who are not medically trained may well be able to perform treatments on the public. While the Care Quality Commission (CQC) monitors registered practices – including inspection of treatments, documentation, administers and the premises – those who are not registered are able to carry out treatments.

How to Sort the Bad from the Good

With surgery, the best way to find a skilled and qualified surgeon is to do your research, ask the right questions and visit the practitioner – preferably more than once – before going ahead with the procedure. Here are some useful tips on how to find the right surgeon for you:

  • Look on the General Medical Council (GMC) Register to see whether the surgeon is qualified and has undergone specialist training in plastic surgery. You can do so online, or by calling 0845 357 3456.
  • Ask the surgeon how many procedures they have performed in the past of the particular surgery you are interested in.
  • Ask the surgeon how frequently they have performed this type of surgery.
  • Ask how many years they have been operating.
  • Other questions include: What results can be achieved with surgery? What risks are involved? What type of anaesthetic will be used? Will there be an anaesthetist present? Where will the operation be performed?

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The Moral of the Story

In order to receive safe, professional care before, during and after a cosmetic procedure, it is paramount to do your research. Ask questions – there are never too many. You should completely feel at ease and confident with the surgeon operating on you, and confirm whether an anaesthetist will be present on the day, if necessary. All forms of sedation and anaesthetic come with risks attached, but provided a specialist who understands dosages is there throughout the procedure, it is safe.

For more information about surgery and the procedures available at PHI Clinic, please call 0207 034 5999.

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