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Anesthesia 'process' starts with first office visit

Article-Anesthesia 'process' starts with first office visit

S-Caine Peel is a relatively new topical anesthetic that´s applied as a cream, solidifies as a mask or film, and then peels off.
Lake Buena Vista, Fla. — Minimizing the pain of a cosmetic surgery procedure should start long before anesthesia is administered, according to dermatoplastic surgeon Christopher Zachary, M.D.

Dr. Zachary, clinical professor and co-director of the Dermatologic and Laser Center at the University of California, San Francisco, says the physician should try to create a relaxed environment — what he calls "a bubble of comfort" — by displaying quiet confidence and making sure the patient understands everything about the upcoming procedure, and thus is comfortable with it.

Dr. Zachary discussed the "bubble of comfort" and other topics concerning anesthetics during his presentation, "Anesthetics for Cosmetic Procedures," at the recent Cosmetic Dermatology Seminar here.

"My anesthetic process, if you will, starts when I meet the patient in my office for the first time," Dr. Zachary says. "Pain has emotional as well as sensory components, and it's an experience that varies with each individual. I try hard to create a feeling of quiet confidence to help the patient relax, and I do everything I can to make sure the patient understands what's going on with the procedure. The way you listen to a patient, for example, is important in instilling confidence, and the use of humor, and, of course, answering any questions the patient might have. Making a patient comfortable goes beyond just the administering of anesthesia."

Increasingly, it also goes beyond having just the patient, physician and/or physician's assistant present during the procedure.

Patient comfort "The concept of patient advocacy is gaining momentum," Dr. Zachary says. "In short, this is the idea of patients choosing a friend or family member to be with them, either through the entire process or just the procedure itself. It's just another way to help the patient feel more relaxed and at ease."

Other methods Dr. Zachary cites are rather basic, but are sometimes overlooked. It's important that the bed on which the procedure takes place is comfortable, that it has a soft covering, that warm blankets are at hand, and that music — preferably the kind the patient enjoys — is available.

Dr. Zachary says the benefits of all this attention to patient comfort is that the more relaxed and comfortable the patient is, the lower the patient's blood pressure will be and, generally, the lower the possibility of complications occurring during a procedure.

"There is also the fact that it's important for the physician to be as relaxed and comfortable as possible," Dr. Zachary says.

Topical anesthetics As for the anesthetics themselves, Dr. Zachary focuses on the topical variety: the creams and ointments that traverse the skin to nerve endings in the dermis.

"The benefits of the topicals is that they don't involve needles, often a big plus when you're talking about patients being relaxed, and they're more convenient to use — in some cases, they can be applied by the patient before coming into the office for the procedure," Dr. Zachary says. "On the downside, there is often a cost factor and there are varying degrees of efficacy among topical anesthetics."

Dr. Zachary says there are some issues with topicals related to the extent to which they've been tested.

"My advice is to keep to the topicals that have been thoroughly tested, because there are those out there that haven't been," he says. "With whatever topical anesthetic you choose to use, proper application is critical. Each manufacturer's instructions should be followed to the letter, and it's especially important to thoroughly educate the patient about this in cases where the patient is applying it before coming in for the procedure."

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