Is general anesthesia truly universal? : A surgeon's consideration of the risk of thrombosis and embolism and the reality of private clinics
Hello? Chaebi Everyone, Dr. Ai lipoplastic surgery. Han Gru (Chief Surgeon)It is.
When conducting liposuction or body shaping consultations, one of the things patients are most concerned about is the method of anesthesia. often “Isn’t general anesthesia the most convenient and versatile, so you can wake up soundly asleep without knowing anything at all?”People often ask,
Of course, from the surgeon's perspective, general anesthesia, in which the patient does not move at all, can make the surgery much easier. However, if you take a dispassionate look at the surgical environment of a local private practice rather than a university hospital, from the perspective of a surgeon who deals with basic physiological and anatomical principles, the story is completely different. Today General Anesthesia (GA)Wow Sleep/sedation-induced anesthesia (MAC / IV Sedation)One of the most fatal complications after surgery Venous thromboembolism (VTE)—In other words, blood clots accumulate in the deep veins of the legs. Deep Vein Thrombosis (DVT)and block pulmonary blood vessels Pulmonary embolism (PE)—I would like to tell you what difference it makes in the risk of occurrence based on medical evidence and the reality of private practice.
1. General anesthesia vs. anesthesia under sedation: key differences in blood clot risk
General anesthesia and induced sedation anesthesia do not simply differentiate the patient's level of consciousness during surgery. The three major conditions for the formation of blood clots Virchow's TriadWhen comparing the two anesthesia methods, clear physiological differences occur in the blood flow and blood coagulation system within the human body.
| Evaluation items | General Anesthesia | Sedation induction / regional anesthesia + sedation (MAC / Sedation) |
|---|---|---|
| relative blood clot risk | high (reference group) | low (Risk reduction trend of about 35-45% [2. Meta-analysis of thrombosis by lower extremity surgery anesthesia method]) |
| venous stasis (Venous Stasis) |
Use of muscle relaxants and suppression of spontaneous breathing Intensified blood flow stagnation | Maintaining spontaneous breathing, when accompanied by local anesthesia Improved blood flow by dilating blood vessels |
| hypercoagulable state (Hypercoagulability) |
Due to the increased stress response to surgery Activation of the coagulation system | By suppressing the neuroendocrine stress axis Relieves coagulation activation |
| Early mobility after surgery | Due to residual anesthetic gas and narcotic analgesic movement delay | Rapid recovery of consciousness and pain control Early mobility possible [1. Comparison of early behavior and thrombotic indicators] |
① Differences in Venous Stasis
One of the biggest causes of blood clot formation is stagnation, where blood flow slows and pools.
② Body stress response and hypercoagulability
The physical stimulus of surgery easily causes blood to harden (hypercoagulable state) to defend our body.
2. Fatal gap between the other side of the latest thesis and the ‘reality of private practice’
Past data (early 2000s) reported that sedation/regional anesthesia reduces the risk of blood clots by almost half (45%) compared to general anesthesia [2]. On the other hand, according to the latest studies (as of 2024-2026), in a modern university hospital surgical environment where post-operative thromboprophylaxis protocols such as anticoagulants and compression devices are basically well administered, the gap in final DVT/PE incidence between the two anesthesia has narrowed to the point where it is not statistically significant [1].
① Absence of preventive treatment with antithrombotic drugs (Clexane, etc.) before and after surgery
It is used to prevent deep vein thrombosis (DVT) in local plastic surgery, which is the mainstay of cosmetic surgery. Clexane (enoxaparin) There is no way to use anti-thrombotic drugs such as pre- or post-operative treatment. There are problems with rising drug costs and poor patient compliance with injection treatment, but above all, due to misconceptions and resistance to bleeding and bruising, which are unique to the cosmetic surgery industry, blood clot prevention drugs are excluded altogether.
Low-molecular-weight heparin anticoagulant administered as a standard drug to prevent venous thromboembolism in the surgical department of a university hospital.
Prefilled syringe for subcutaneous injection into the abdominal wall filled with a single dose — virtually no administration in private clinics due to concerns about bleeding and bruising and cost issues
② Not wearing lower body pneumatic compression device (IPC) and medical compression stockings.
When the pumping action of the lower body muscles stops due to general anesthesia, the calves and thighs are periodically squeezed externally. Lower body pump device (IPC, intermittent air compression device)me Medical anti-embolic compression stockingsIt is mandatory to wear. However, in actual general anesthesia operating rooms, it is extremely rare for these basic physical prevention equipment to be properly equipped and applied.
An essential equipment for university hospitals to prevent blood pooling by sequentially compressing the ankles, calves, and thighs in place of the lower body muscle pump that stopped during general anesthesia.
Medical compression stockings that gradually reduce pressure from the ankle to the thigh to prevent dilation of lower extremity veins and stagnation of blood flow during surgery.
3. The nature and ethics of medical care as a surgical specialist
Every time I encounter this reality of private practice, as a doctor, I feel a bit absurd and have deep doubts. Is it really true that the anesthesiologists participating in the surgery do not check the risk of blood clots?
I believe that the anesthesiologist in question did not have in-depth experience in ultra-obesity metabolic surgery or large-scale orthopedic surgery for high-risk groups of blood clots during his training at a university hospital. If not, there would have been strong demands or pressure from the hospital owner (plastic surgeon).
If it's the above problem, it's fortunate. Even though I may have given up on my ethics as a medical professional, At least they are aware of the risk of thrombosis and embolism that comes with general anesthesia.Because it is. However, if general anesthesia is performed inertically without even being aware of these physiological risks, that would be the worst thing. Not only is there a lack of ethics, but even the meaning of existence as an expert has been completely lost.Because it is.
[Surgeon Dr. Han Gru (Chief Surgeon)'s medical principles: Safety-first anesthesia and surgery principles]“As a surgeon, it is a non-negotiable standard to choose patient safety and a quick recovery process after surgery, even if it requires a little more work and is more difficult, rather than a method that allows the surgeon to complete the surgery comfortably and quickly.”
4. Anesthesia and surgery scheduling that prioritizes patient safety
From the perspective of the surgeon performing the surgery, general anesthesia is more comfortable than when the patient is breathing on his own, but performing the surgery while under anesthesia under sedation and sedation while applying detailed local (tumescent) anesthesia can be a bit more difficult and labor-intensive. But When considering patient safety, it is my firm belief as a surgeon that surgery through induction of sleep and sedation is much safer.It is.
especially liposuction surgeryThis is a surgery that is mainly performed on people who are overweight or have a high body mass index (BMI), which in itself puts them at high risk of venous thrombosis. It is never advisable to apply general anesthesia to patients at high risk for thrombosis without appropriate anticoagulation or pneumatic compression device (IPC) for the convenience of the operator.
Of course, if the area to be suctioned is large and the surgery time is long, general anesthesia may be discussed for various other medical reasons. However, even in such cases, rather than performing surgery on the entire body simultaneously with one unreasonably long general anesthesia, The patient and doctor coordinate the schedule through sufficient consultation to safely divide the surgical area (split surgery).I believe this is the wisest way to reduce the physiological burden and risk of blood clots for this patient.
5. Q&A about anesthesia and blood clot safety, which patients are most curious about
If you perform liposuction under sedation (induced sedation) anesthesia, won't you wake up or feel pain during the surgery?
No need to worry. Sleep and sedation-induced anesthesia is performed by precisely injecting a local (tumescent) anesthetic solution that blocks pain signals at the surgical site while inducing a deep sleep that allows the patient to breathe safely on his or her own. You can sleep and wake up comfortably without pain, but the burden on your body is much less since you don't have to use a respirator or muscle relaxant.
Isn’t general anesthesia done with a large machine like at a university hospital actually safer?
The risk of general anesthesia can be effectively controlled in a university hospital operating room where all thrombosis prevention safety nets, such as administration of antithrombotic injections (e.g., crexane), intensive care unit-level monitoring, and lower body pneumatic compression devices (IPC), are operated simultaneously. However, in a general practice environment where such preventive measures are easily omitted, sleep/sedation-induced anesthesia, which allows the patient to breathe independently and maintain blood flow to the legs, is much safer in terms of preventing thrombosis and embolism.
Is full-body large-volume liposuction, where there is a lot of fat to be removed, such as the abdomen, thighs, and arms, possible under sedation?
If too many areas are operated on for a long time at once, the total amount of anesthetic administered and the burden of bleeding increases, and the time spent lying on the operating table increases, dramatically increasing the risk of blood clots. Therefore, rather than unreasonably removing the entire body in one day, performing planned surgery (split surgery) on parts such as the abdomen, upper body, and lower body according to the patient's physical strength and safety standards allows for faster recovery and higher completeness of results.
Can I know before surgery if I am at a higher risk of developing thrombosis than others?
Those who are overweight or obese with a high body mass index (BMI), are taking oral contraceptives or hormones, have varicose veins, smokers, or have jobs that involve sitting for long periods of time have a relatively high risk of blood clots. If you transparently inform the medical staff of the medications you are taking and your general health status during the consultation, we will design the safest anesthesia plan and guide to early walking after surgery.