Several kinds of clinicians can deliver anesthesia for cosmetic surgery in the United States. The two that patients hear about most are physician anesthesiologists and nurse anesthetists, and a patient booking an elective operation has good reason to ask which one will be at the head of the table.
Leo Lapuerta, MD, FACS, a triple board-certified plastic surgeon in the Houston area, has made the answer a fixed policy. He works only with physician anesthesiologists, never nurse anesthetists or anesthesia assistants. His practice explains the reasoning in its guide to anesthesia for cosmetic surgery in Houston, and the explanation gives patients a useful set of questions for any consultation.
Two training paths, side by side
- Physician anesthesiologist: a medical doctor who completed medical school and then residency training in anesthesiology. Dr. Lapuerta’s practice describes these clinicians as medical doctors who specialize in anesthesia.
- Nurse anesthetist: a registered nurse who completed advanced graduate training in anesthesia. Nurse anesthetists deliver anesthesia in many settings, and the rules on how they work with physicians vary by state and facility.
Both are trained professionals. The difference lies in the route each took and in how the operating room divides responsibility, which is where Dr. Lapuerta’s practice focuses its argument.
The practice’s reasoning
According to the practice, a physician who specializes in anesthesia is dedicated to the patient’s safety and comfort through the pre-operative period, the surgery and recovery. That arrangement lets Dr. Lapuerta give his full attention to the operation.
The practice contrasts this with surgeons who provide their own anesthesia or who use nurses or nurse anesthetists. In the practice’s view, those surgeons must split their attention and responsibility between performing the surgery and overseeing the anesthesia. Patients can weigh that argument for themselves, but the question it raises applies anywhere: who holds final responsibility for anesthesia while the surgeon operates?
The practice adds a continuity point. Dr. Lapuerta has worked for more than 15 years with a select group of 5 anesthesia doctors who have extensive experience in outpatient anesthesia and in anesthesia for plastic surgery.
Inside one practice’s anesthesia plan
Patients having surgery at the practice’s accredited on-site facility meet their anesthesia doctor before surgery to discuss options. The facility is accredited to offer local anesthesia, sedation with monitored anesthesia care, total intravenous anesthesia (TIVA), general anesthesia and regional anesthesia. The anesthesia doctor builds a plan around the patient’s medical history, the planned procedures and the patient’s preferences.
Patients often worry about waking during surgery. The practice describes awareness as a rare but known complication, occurring in about 1 to 2 cases per 1,000, and more often in patients with serious medical histories or those undergoing trauma surgery, emergency C-sections or major cardiovascular surgery. As an added measure, the facility uses a BIS monitor, which tracks the patient’s EEG throughout surgery and produces a number and waveform that help the anesthesia doctor adjust the anesthetic.
Dr. Lapuerta uses local anesthesia in all of his surgeries. The practice says this blocks pain signals from the surgical site and helps reduce the need for narcotics during and after surgery, which can also lower the odds of nausea and vomiting. The practice also describes Exparel, a local anesthetic used in some surgical procedures that is injected during surgery and releases over three days to help control pain afterward.
For TIVA, the practice uses a continuous infusion of propofol. According to the practice, propofol has an anti-nausea effect, takes effect fast and wears off fast, and carries no risk of triggering malignant hyperthermia, a rare genetic reaction to certain anesthetics that can be life-threatening.
Questions to bring to a consultation
- Who will administer my anesthesia, and what is that person’s training?
- Will the anesthesia provider be with me for the entire operation and in recovery?
- Will I meet that provider before the day of surgery?
- Which types of anesthesia does the facility offer, and which do you recommend for my history?
- Is the surgical facility accredited, and by whom?
Dr. Lapuerta, who has more than 30 years of experience and owns and operates a QuadA (AAAASF) accredited surgical facility, built his anesthesia policy into the way his operating room runs. Any surgery and any anesthetic carries risk. Ask these five questions and you will know, before signing anything, the name and training of the person responsible for your anesthesia.
This article is for general information only and is not medical advice. Results vary from patient to patient. Consult a board-certified plastic surgeon or your physician about your own situation. Written in partnership with Joseph Lambert, a publicist working with Leo Lapuerta, MD Plastic Surgery.