Anesthesia - which to choose?

[pinkly]

I am having a minor procedure next Friday. It is removal of a largish lipoma. I am apparently being given the choice of a local anesthetic just to numb the area (not sure if that terminology is correct) or to be put under. The doctor said that sometimes when people choose to stay awake they can react differently to the situation, be unable to stay still for the incision, etc., and make it difficult, if not a tad dangerous.

Has anyone had a procedure where you’ve been given a choice? Any personal anecdotes would actually be welcome. I’m a bit nervous.

Thank you.

[audry80]

How big is the lipoma and where is it located?

[pinkly]

Jan 23, 2021 0:26:59 GMT -5 audry80 said:

How big is the lipoma and where is it located?

He said 4-5cm. It’s on the outside of my upper right arm. I’ve had it since at least 2016 but it has become painful at times, hence the removal.

[pinkly]

Jan 23, 2021 0:45:25 GMT -5 mofongo said:

Jan 23, 2021 0:40:14 GMT -5 pinkly said:

He said 4-5cm. It’s on the outside of my upper right arm. I’ve had it since at least 2016 but it has become painful at times, hence the removal.

I would try to do local for that, and they should be able to give you a little something for nerves.

Thank you! I think I just needed someone to tell me it was ok to go that route. I really don’t like the idea of being fully under.

[wanderingback]

Is it general anesthesia or conscious sedation or mac sedation (usually propofol)? I assume it’s not general anesthesia. The other options would make a difference to me as well. I’ve never had propofol but my patients seem to love the nap they get with it. Sometime my patients to get nauseous after conscious sedation and the one time I had it when I was younger I was also nauseous afterwards, but otherwise no biggie. It’d also depend what I had planned for the rest of the day and if I had someone to bring me home (i mostly live alone and don’t have a car).

For small skin lesions conscious sedation or mac has never been an option for me when I do them on patients, so I don’t think it’d be a big deal to go with local but maybe your doctor things for some reason it’ll be extra painful? Maybe get clarification.

[audry80]

I would do local. I had a large cyst on my chest that was removed with local and I was fine. Didn’t feel any pain just pulling.

[sequins]

Jan 23, 2021 0:49:41 GMT -5 wanderingback said:

Is it general anesthesia or conscious sedation or mac sedation (usually propofol)? I assume it’s not general anesthesia. The other options would make a difference to me as well. I’ve never had propofol but my patients seem to love the nap they get with it. Sometime my patients to get nauseous after conscious sedation and the one time I had it when I was younger I was also nauseous afterwards, but otherwise no biggie. It’d also depend what I had planned for the rest of the day and if I had someone to bring me home (i mostly live alone and don’t have a car).

For small skin lesions conscious sedation or mac has never been an option for me when I do them on patients, so I don’t think it’d be a big deal to go with local but maybe your doctor things for some reason it’ll be extra painful? Maybe get clarification.

Same q. Is it general anesthesia or sedation?

I had my inguinal hernia repair under sedation with local. It was NBD.

[winecat]

I wonder if he says that because you'll have to lay in a somewhat uncomfortable position for a while? Upper, outside of your right arm would be below your shoulder and above your tricep? So you'll need to be on your stomach with your arm out somehow? I imagine that staying in an awkward position will be the hardest part if I'm imaging where you're talking about correctly.

I had to have a mole removed on the front side of my upper thigh. It was much smaller but they were worried about it so they took a wide margin. The incision was about 5 cm long and 1.5 cm deep, I think. The length is correct but I'm not sure about the depth. It was pretty deep though. I had a divot in my thigh due to the depth they had to take out. I only had local anesthesia for it. I was a little nervous but it wasn't a big deal. I didn't feel anything. But I could lay comfortably on my back and they put up a curtain so I couldn't see. It was a long procedure time though since they had to administer the anesthesia more slowly to get the depth needed. I think it would have been hard to be still for as long as I would have had to be if I wasn't in a comfortable position. I could scratch my nose or whatever I needed to do without disturbing the doctor. The nurse scratched my leg if I needed it. lol I think it would have been really hard to lay still in an uncomfortable position for a couple of hours. I agree about asking if sedation is an option.

[aprilsails]

Have you been under general before? I recently had an operation for a cyst removal and because of Covid I had the option of general or a spinal block. I’ve had a bad reaction to a spinal before so I opted for general which went great the one previous time. This time my cocktail was not so great and I woke up pretty nauseous, but whatever. It was a much longer procedure at 1 hour as compared to 20 minutes the first time. That also played into my desire to not be awake.

[georgeglass]

Jan 23, 2021 0:49:41 GMT -5 wanderingback said:

Is it general anesthesia or conscious sedation or mac sedation (usually propofol)? I assume it’s not general anesthesia. The other options would make a difference to me as well. I’ve never had propofol but my patients seem to love the nap they get with it. Sometime my patients to get nauseous after conscious sedation and the one time I had it when I was younger I was also nauseous afterwards, but otherwise no biggie. It’d also depend what I had planned for the rest of the day and if I had someone to bring me home (i mostly live alone and don’t have a car).

For small skin lesions conscious sedation or mac has never been an option for me when I do them on patients, so I don’t think it’d be a big deal to go with local but maybe your doctor things for some reason it’ll be extra painful? Maybe get clarification.

As I started reading this thread, I thought - ooohhh, can OP get propofol? Best nap ever!

[minzy]

I don’t have too much to add, except that on Dr. Pimple Popper, people seem to do just fine with local for the removal of lipomas.

I’m having a 10-15 minute procedure in a few weeks and they asked if I wanted to go under or not. I’m choosing not, because we need me to be able to drive myself home just in case it wouldn’t work schedulewise for the rest of my family. But I seriously considered it. Time away, knocked out “alone” during the day - despite what they’ll be doing to me - sounds kind of delightful right now.

Good luck!

[1yeartogo]

Mine are teeth related. When I was a young teen I had dental surgery to remove an abscesses tooth in my gum. They gave me general and apparently too much. I stopped breathing and they had to give me oxygen/revive me. I don’t remember that but I do remember waking and being unable to walk, etc.

12 years later as an adult I needed to get bone grafts and a dental implant done for that same area (3 different procedures). They gave me choice of local or general. I chose local. Yes it was hard to sit still especially with someone’s hands in my mouth for long periods of time and my jaw got sore from having to open for so long, but I felt nothing but pressure in all 3 procedures. I liked knowing what was going on with my body and my recovery after them was quicker/better for me.

I vote go with local if you have any concerns.

[icedcoffee]

Propofol is the shit. Ask for that. It’s seriously amazing. 😴

[whattheheck]

If you are concerned about nausea with a general/sedation you can ask to have an anti-nausea drug added in. I am VERY prone to nausea and vomiting with any type on anesthesia and that really helps but I have to ask for it, it’s not automatic.

[underwaterrhymes]

I had a lipoma removed from my thigh back in 2015 with just local. It was fine, but the dermatologist did a terrible job and I had issues with infection and scarring.

I think you’d be fine with a local, but I highly recommend using a plastic surgeon.

Having said all of that, I agree that conscious sedation is amazing.

[Deleted]

Is doing a Twilight sleep an option? Years ago I had a tumor removed from my thumb. They gave me the twilight which basically put me to sleep for the part where they did the injections for the local and then I woke up but was still in la-la land for the procedure itself.

ETA: reading the other comments, I think I’m talking about Propofol. Do that. I think that’s also what they give me when I get Endoscopies, best nap ever.

[brewco]

I work in dermatology surgery and we generally recommend doing that type of procedure under local only. If you choose sedation or general anesthetic it's a much longer recovery the day of surgery and you'll need a driver/caregiver. Local offers a faster recovery and shorter procedure, also less chance of reaction to the anesthetic.

[cricketintx]

Jan 23, 2021 7:57:42 GMT -5 whattheheck said:

If you are concerned about nausea with a general/sedation you can ask to have an anti-nausea drug added in. I am VERY prone to nausea and vomiting with any type on anesthesia and that really helps but I have to ask for it, it’s not automatic.

I am a person who gets *extremely* nauseated after anesthesia, and the anti-nausea drug never helps me. I would vomit for DAYS after even short procedures.

The only thing that finally helped me was one anesthesiologist deciding he was going to get to "fix" it once and for all, and he figured out that it's the gas part of anesthesia that makes me sick. So now I request no gas, just propofol (because, as everyone in this thread has pointed out, propofol is pretty cool.)

So if you're someone who gets nausea, try the anti-nausea drug, but if it persists, ask for "no gas."

Signed, someone who is undergoing another procedure soon.

[sadlebred]

minzy I was going to say the same thing about Dr. Pimple Popper!

I am much happier with IV sedation usually. Having said that, I've had a (non-dental) procedure with local only. It wasn't pleasant, but it wasn't horrible. I could feel pressure and push/pull but no pain. I drove myself home afterwards.

[scm1011]

I had a slightly larger lipoma removed from my back a few years ago under local. It was no big deal.

[joy]

My gosh, propofol was ...nothing... literally. I closed my eyes; I opened them thirty min later. I felt no different. What am I missing?

[Mrs. ChanandlerBong]

Jan 23, 2021 9:26:25 GMT -5 joy said:

My gosh, propofol was ...nothing... literally. I closed my eyes; I opened them thirty min later. I felt no different. What am I missing?

For me it was that for the 10 minutes I was out, I woke up feeling like I’d slept for 8 hours.

[CloudBee]

I think I would call and speak with the nurse or doctored ask why general is an option. Are they going to be digging a lot? Will the incision be particularly deep?

I've been awake for a few procedures with similar incision lengths. There was a lot of tugging, which was uncomfortable. Had I not needed to be awake I would have requested to be put out. (Cardiac procedure where they inserted a device in my chest and needed some feedback.)

Another time I had some lymph nodes resected from my neck and they pushed general due to the location. My head would have been draped and I would have had to stay in a very uncomfortable position for the duration.

I was awake during my c-section and the one thing I can't get over from that experience was all of the tugging and talking going on around me.

If it's a really simple procedure I would go with local.

[rubytue]

Given the choice, I think I’d prefer local with Valium or other sedatives. Means you still need a driver, but still worth it. I had a lymph node in my neck biopsied that way, and it was one of my favorite (probably not quite the right word) surgeries. But I needed the sedative to help with the burger to squirm.

I actually just had something this week where they put me out to prevent all movement, but the area itself was small enough it could have been local. Probably. Just a dime sized skin removal. I need to know what they did because that was my best wake up yet. I didn’t even need my usual 2 hour nap when I got home.

My preference is “twilight.” I don’t know they drugs or what exactly it means. I just know I’m sick of having things done while I am awake and conscious (4 biopsies over the years, including bone marrow and uterine). And nope. Done with that shit.

[icedcoffee]

Thinking about this more. I almost wonder if he meant the choices were local or conscious sedation. General seems like wayyy overkill. I’d call and clarify if he meant local (numb it) or conscious sedation (basically knock you out for a few minutes). If this is true go with the conscious sedation. It’s lovely.

[wanderingback]

Jan 23, 2021 4:40:09 GMT -5 aprilsails said:

Have you been under general before? I recently had an operation for a cyst removal and because of Covid I had the option of general or a spinal block. I’ve had a bad reaction to a spinal before so I opted for general which went great the one previous time. This time my cocktail was not so great and I woke up pretty nauseous, but whatever. It was a much longer procedure at 1 hour as compared to 20 minutes the first time. That also played into my desire to not be awake.

Maybe they do things differently in Canada, but general anesthesia seems like a little bit of overkill for a small cyst or lipoma on the skin like OP described.

OP- general anesthesia is where you’re completely unconscious with no reflexes, so they intubate you (breathing tube) to breath for you. Anesthesia is generally safe, but there’s more risk with general anesthesia and a breathing tube, than with mac (propofol) and obviously local. Of course, do what you think is best for you and the procedure, but I’d definitely recommend asking more questions if it’s not clear why the doctor is offering you general anesthesia for a small/short procedure.

[yourmother]

Years ago I had a ganglion cyst removed from the top of my wrist and was put completely out.

Maybe I’m weird, but I’ve been out out like that several times in my life (oral surgery, colonoscopies, endoscopy) and really enjoyed my experiences.

I also get laughing gas at the dentist every chance I get.

[aprilsails]

Jan 23, 2021 12:26:51 GMT -5 wanderingback said:

Jan 23, 2021 4:40:09 GMT -5 aprilsails said:

Have you been under general before? I recently had an operation for a cyst removal and because of Covid I had the option of general or a spinal block. I’ve had a bad reaction to a spinal before so I opted for general which went great the one previous time. This time my cocktail was not so great and I woke up pretty nauseous, but whatever. It was a much longer procedure at 1 hour as compared to 20 minutes the first time. That also played into my desire to not be awake.

Maybe they do things differently in Canada, but general anesthesia seems like a little bit of overkill for a small cyst or lipoma on the skin like OP described.

OP- general anesthesia is where you’re completely unconscious with no reflexes, so they intubate you (breathing tube) to breath for you. Anesthesia is generally safe, but there’s more risk with general anesthesia and a breathing tube, than with mac (propofol) and obviously local. Of course, do what you think is best for you and the procedure, but I’d definitely recommend asking more questions if it’s not clear why the doctor is offering you general anesthesia for a small/short procedure.

Oh I had a cyst in a very unfortunate location that basically became a fistula so this was not a dermatologist issue by the point I had surgery. I had an absolutely horrific response to my first spinal (couldn’t walk for almost 24 hours and had to have a catheter for 2 days) so there was no way I was choosing a spinal over general.

But thats me, and I used my previous experience to decide that a general isn’t a terrible option for me so I would be ok with it if recommended. For something on my arm, I would probably choose local to be honest.

[cattledogkisses]

Jan 23, 2021 7:57:42 GMT -5 whattheheck said:

If you are concerned about nausea with a general/sedation you can ask to have an anti-nausea drug added in. I am VERY prone to nausea and vomiting with any type on anesthesia and that really helps but I have to ask for it, it’s not automatic.

Yes, this is a possibility. I’ve been under general three times, and each time they gave me Zofran (I didn’t even have to ask for it actually).

[namasteak]

When I had a suspicious mole (3cm) removed on my back I had a Valium + local and was fine. I would ask for that.