Anesthesia: One of the Risks of Cosmetic Surgery


Valerie DeBenedette, Senior Medical Editor

Valerie DeBenedette is a science writer who specializes in keeping people informed about medicine and their health. She has more than 20 years of experience writing for newspapers, magazines, and websites and has written about most areas of medicine. For many years, she was a contributing writer to Cosmetic Dermatology and to Drug Topics, the leading pharmacy trade magazine. She also was a contributing editor to The Physician and Sportsmedicine for many years. She has written about most fields of medicine, including dermatology, sportsmedicine, ophthalmology, general surgery, orthopedics, and women's health; as well as public health policy and the pharmaceutical industry. In addition, she is the author of Caffeine, a book for young people. She is a member of the National Association of Science Writers.

April 21 2008

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Anesthesia is what makes surgery possible. Before modern anesthesia was available to deaden pain and create unconsciousness, no one would submit to surgery unless it was a matter of life or death, and sometimes even the risk of death was not enough motivation to go under the scalpel while fully conscious and feeling the pain.

But now we tend to take anesthesia for granted. Surgery, especially cosmetic surgery, has become so safe that we forget that it is not without risks, and that a good portion of those risks are related to anesthesia.

This was brought home by the recent death of Stephanie Kuleba,18, of Boca Raton, FL, during plastic surgery to fix asymmetrical breasts and an inverted nipple. What should have been a routine procedure in her surgeon's office turned into a nightmare. She developed problems and was taken to a hospital, where she died a day later. Her surgeon, Steven Schuster, MD, is board-certified plastic surgeon in Boca Raton.

Again, it must be stated that the vast majority of surgeries go well. Anesthesia is extremely safe. Statistics from 2000 show that there were about 28 million people who underwent anesthesia in any given year and that the mortality rate was 1 death in 250,000 anesthetizations. Compare this to mortality rates of 41 in 250,000 for motor vehicle accidents and 22 in 250,000 for household injuries.

Stephanie's death was due to a rare inherited condition called malignant hyperthermia (MH). People who are susceptible to MH react badly to certain gas anesthetics. The metabolism of their muscles goes out of control and overwhelms the body's ability to supply muscles with oxygen. The body may become rigid and body temperature can shoot up to 110 degrees, a dangerously high fever.

MH is rare, said Barbara Brandon, MD, Professor of Anesthesiology at the University of Pittsburgh Medical Center in Pittsburgh, but added: "The problem is underestimated." Dr. Brandon is also director of the North American Malignant Hyperthermia Registry. Cases of MH may often go unreported, she noted. Although it can be very severe and life threatening, there are milder cases of it that are treated successfully and that do not get reported, she explained. The ballpark estimate is that there is about 1 episode of MH in 300,000 uses of anesthesia.

Symptoms of MH may be immediate with the start of anesthesia or may occur later during surgery, Dr. Brandon noted. "It can come up very gradually." Some of the first physical changes may be an increase in heart rate or a rise in blood carbon dioxide levels, which are findings that are not uncommon during surgery, she explained. Skin temperature may stay near normal while the core body temperature rises dramatically, she added.

Not only is malignant hyperthermia very rare, you would not know you are susceptible to it unless a close relative (parent, sibling, perhaps first cousin) was found to be susceptible. And, outside of taking a biopsy of muscle tissue and testing that, there is no way to find who has it besides giving them gas anesthesia. If your parents or siblings have never had general anesthesia (or had some form of anesthesia other than most gas anesthetics) there is no way to tell that you might be susceptible.

If one parent is MH susceptible, each child has a 50% chance of being MH susceptible. MH is one reason why you are asked if you or any member of your family have ever had a problem with anesthesia. If anyone in the family has had MH, the whole family should consider getting medical ID bracelets that warn about being MH susceptible.

A drug called dantrolene must be given intravenously as soon as possible after MH is recognized. Most hospitals have dantrolene on hand, but how frequently it is available in surgical suites in a surgeon's office is not known. Because of dantrolene, the death rate from MH has gone from 80% down to 5%.

The Malignant Hyperthermia Association of the United States runs an emergency hotline to advise surgeons and anesthesiologists of what to do when MH occurs. The MH hotline is used several hundred times a year, Dr. Brandon said. Stephanie's doctor, Dr. Schuster, and his anesthesiologist are known to have called the hotline for advice when signs of MH were seen with her.

MH is not the only possible complication from anesthesia and is far less common than others. You could have an allergic reaction to any anesthetic being used (MH is not an allergic reaction, by the way). You could vomit up some stomach contents and start to choke. You could suffer a spasm of your airways. Anesthesiologists (medical doctors) and anesthetists (usually nurses specially trained in anesthesia) are experienced at recognizing problems early and treating them quickly. The risk factors for having a problem with anesthesia include having heart, circulatory, or lung problems; diabetes; poor liver function; poor kidney function; and being obese. Being a smoker or having a history of abusing alcohol are also risk factors for having problems with anesthesia.

The bottom line is that anesthesia is very safe, but nothing is risk free. You will always have to weigh your own personal risk factors against the benefits of the surgery that you are having.