Twilight IV anesthesia for plastic surgery

Twilight anesthesia, or intravenous (IV) anesthesia, can be used for both short (2 hours) surgeries as well as for longer, multiple procedure cosmetic surgery cases. I prefer twilight anesthesia because it offers several advantages over general anesthesia, one of which is the quicker recovery time for the patient immediately following the surgery.

To help illustrate how well patients do during recovery, I’ve gotten permission to film two of my patients immediately following their surgeries. Each patient has just undergone cosmetic surgery with IV anesthesia in our AAAASF accredited surgery center here in Baltimore.

The first patient is filmed about 30 minutes after her totally routine breast augmentation, a relatively short procedure, done with nerve blocks and IV sedation. You can read more about what I use for a safer, less painful breast augmentation here.

The second patient is filmed about 40 minutes after her longer, multi procedure surgery. This patient experienced a significant weight loss and her surgery included an inner thigh lift followed by a tummy tuck and a breast augmentation with mastopexy. The surgery lasted about nine hours. The dangers of multiple procedure surgeries are related to the general anesthesia commonly used. I have patients who undergo longer surgeries like this do quite well using IV sedation and wanted to show this as well.

I want to thank both of these patients for letting me speak with them on camera during recovery to help others see the benefits of using IV sedation for cosmetic surgery. Read more about the advantages of IV sedation over general anesthesia and why I think it’s great for my patients.


Hi. I’m Dr. Ricardo Rodriguez and this is my video blog I’m trying to do every day, keep the questions coming, guys. But anyways, today I want to show you two patients. One of them had a breast augmentation, and we did it with nerve blocks to block away all the pain before I even started the surgery. And then, of course, we do it the way we usually do it here, which is with intravenous sedation, which i think is great, much better than general anesthesia. Patients patients wake up much quicker, they wake up without nausea, and for a short little procedure like a breast augmentation, where we do the nerve blocks before, you’re going to be amazed to see how well this patient recovers.

Anyways, let me just show you a little bit of a film clip of her, just really it’s about half hour after the surgery. let’s take a look at it.

Patient: “Okay, I had surgery 29 minutes ago and I feel great, a little groggy and I’m very happy.”

Dr. Rodriguez: “Did you have nausea?”

Patient: “No nausea.”

Dr. Rodriguez: “Okay. You ready to walk?”

Patient: “Almost. (Giggling). I thought everything went great, I was treated wonderfully, I recommend it to anybody.”

Okay, pretty remarkable, huh?! I mean she just laughs like out loud she’s fully with-it, she’s ready to go home and you know great, that’s like totally routine here.

Now, the second patient I want to show you is one, a little bit longer. As a matter of fact, it was nine hours of surgery. This is, as a matter of fact, that was today. So I’m a little bit tired. But anyways, it was nine hours of surgery. We did an inner thigh lift followed by a tummy tuck and then a breast augmentation with mastopexy – so it was total of nine hours of surgery. She was nine hours under.

The first part of the operation, she was on her stomach laying down; the second part of the operation, of course, she’s on her back and that’s when we did the tummy tuck and the breast augmentation with the breast lift. But what I want you to notice, even though the patient is a little bit sleepy, it’s only 40 minutes after we have left the operating room table; and she’s “with-it” enough that she can tell you, you know, exactly what procedure she had. As a matter of fact, the patient was discharged about half an hour after that film clip was taken. And, you know, our test to see if somebody can be discharged is if they can, you know, walk to the bathroom. I mean that’s how we know, if they can walk to the bathroom, they’re probably going to be alright, you know, at home. Now, obviously, you know, they walk with somebody taking them and all that, but you know it’s – she did just fine.

Patient: “I had an inner thigh lift, tummy tuck, and,um, breast lift with augmentation after losing 150 pounds.”

Dr. Rodriguez: “Are you having any pain now?”

Patient: “My abdomen.”

Dr. Rodriguez: “Uh-huh. Does it hurt a lot or a little bit?”

Patient: “Not a lot, but I feel sensations.”

Dr. Rodriguez: “Okay, how about your breasts, though, do they hurt?”

Patient: “Nope.”

Dr. Rodriguez: “Not at all.”

Patient: “I haven’t used any of the muscles.”

Dr. Rodriguez: “Okay. And how about, have you been able to eat or drink anything?”

Patient: “No. Not yet.”

Dr. Rodriguez: “Well, actually, you don’t remember but you just had some of that water.”

Patient: “Oh, yeah! That’s pretty bad.”

Dr. Rodriguez: “Okay, so you like the pain pumps? You like how they’re keeping you free of pain?”

Patient: “Yes.”

Dr. Rodriguez: “Okay, so say ‘bye’ to the camera.”

Patient (waves): “Toodle-loo!”

A lot of people write about the dangers of multiple procedures. The dangers of multiple procedures are strictly related to general anesthesia. When you do a patient with adequate pain relief after – and the pain relief is very important – they do well under IV sedation.

You know, under IV sedation it’s not like you have a ventilator breathing for you the whole time. The whole time the patient is breathing for themselves and that makes a huge difference in the hemodynamics, or the dynamics of the blood running through the system.

You know, as your chest expands, you’re bringing air in, but you’re also bringing air into the lungs; whereas, when the machine breathes in for you, as it shoots in the air, it squeezes out all the blood until, when you meet the resistance of the chest cage, and then it expands it. So during the time that you’re expanding your lung, you’re really not pushing that much blood flow through and, you know, that is a big, big difference.

The other thing, of course, is you know, the amount of drugs it takes to keep you down and not reacting to a chest tube. When you’re breathing on your own, you know, we can keep you much lighter. Now, you know, what allows us to do this? Well, the use of a lot of tumescent anesthesia and local anesthetics. They are essentially protecting you from pain. So we just want you sedated enough that you’re not moving around so that we can do our surgery, but essentially, a patient can be very “light” when we put them to sleep.

But anyways, I just wanted to show you those two patients to see you know how quickly they can recover, even after a “long” nine-hour surgery, they can do pretty well.

Anyways, that’s my video blog for today. Keep the questions coming, I enjoy reading the questions and hearing from you guys. And, like I said, if there’s any topic you want me to talk about, just, you know, write it in and we’ll address it. Anyways nice to see you again and have a good day.

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