Is Anesthesia Dangerous?

[00:00:00] Announcer: You're listening to Behind the Double Doors, bringing you behind the scenes to learn about cosmetic surgery procedures and the latest non-surgical aesthetic treatments with Houston board certified plastic and reconstructive surgeon Dr. Bob Basu.

Dr. Bob Basu: People do a lot of research to trust that their plastic surgeon is capable and competent and that's the right thing.

But plastic surgery takes a team and who's doing your anesthesia is I think equally important as who's doing your surgical procedure. One of the most important people on our plastic surgery team, someone who you may not even think about is the person actually doing your anesthesia. I'd like to introduce you to Dr.Mary Ellen Firat. She is a board certified anesthesiologist and she heads up our anesthesia services at Basu Aesthetics and Plastic Surgery and our state licensed ambulatory surgery center at Beleza Surgery Center. We've been working together for over 10 years and we've probably done what, over a thousand cases together at this point?

Dr. Mary Ellen Firat: Yeah. Thousands.

Dr. Bob Basu: So welcome Dr. Firat and, uh, I'd like to introduce you to our listeners. Tell us a little bit about yourself.

Dr. Mary Ellen Firat: Sure. My name is Dr. Mary Ellen Firat, born and raised in Alabama. Went to med school in Alabama and came out here. Went to residency at UT Houston and stayed in Houston ever since, like you said, I'm board certified and I've worked in oh, probably at least 10, 15 different hospitals, done every kind of anesthesia you can think of. And I'm so thankful to just be doing plastic surgery.

My dream is to just have one plastic surgeon that I just had a little nice relationship with, I can do my plastic surgery and plastic anesthesia, which was always my favorite because you actually get to see a change right then in your patients. And everyone's here happy, everyone's in a good mood and everyone's pretty healthy. And I love it. And like Dr. Basu said, I've been with you now since it's been at least 10 years, thousands of cases, just with you for at least eight years. And couldn't be happier. Just love it.

Dr. Bob Basu: We've got a lot of questions for you. And so on our website, we have our listeners asking questions. We've got a lot of questions about anesthesia. I'm going to pick a couple that I think we hear often from patients. So we've got a question here from Samantha who actually lives in Cypress, Texas. And she asks, “I'm thinking about doing cosmetic plastic surgery, but I'm petrified about anesthesia. Is it safe? And will I wake up?”

Dr. Mary Ellen Firat: Gotcha, that's not uncommon to be nervous about anesthesia. I think it's kind of like a fear of flying. You're kind of out of control,so to speak. I want to tell people that anesthesia for the most part is very safe, especially in a board certified anesthesiologist’s hands. I feel totally comfortable doing even the sickest of patients because of my experience.

But however, I don't have to, the good thing is everyone who comes over here is pretty healthy. We make sure we screen them and I'm with you the whole time. I make sure that I give you lots of good medicine so that you can help relax, especially in the beginning to kind of allay your fears. And I also, you know, take the time to make sure that I talk with each patient, call their family afterwards and just make sure everyone's on the same page. And everyone is not scared of the anesthesia. As far as waking up, that's, especially with social media and all these movies that have come out in the past, we've had to answer that question quite a bit and it does happen, but it is so very rare and it's usually in a trauma case or a cardiac case. It's not in a young, healthy person undergoing plastic surgery. And I personally have never had any of my patients ever have any kind of recall whatsoever.

Dr. Bob Basu: And we see the same things online and on social media, someone says that they woke up or had some awareness. They didn't feel pain, but maybe they could hear things, yes. Can you explain that? What may be happening?

Dr. Mary Ellen Firat: Well, sometimes when patients are kind of in that in-between phase when, especially when they're waking up from anesthesia, some patients feel like they may have a little bit of awareness that's okay. Because you're waking up. But I think what everyone's really scared of is being paralyzed and awake while someone's operating on me. And that is so very rare. I think the incidence of awareness and recall, which is what I meant when I said that is like 0.001% out of thousands of anesthetics. It's so low. I can understand people being scared of that, especially just from the movies and whatnot, but it's so rare that it happens.

And there are several monitors that we have on you throughout the surgery. We monitor your vital signs so that if you're having a situation like that, or if anyone was having a situation like that, you can definitely tell it under anesthesia. And then we also have certain monitors where we monitor your inexpiratory gas, which is the actual hypnotic that keeps you asleep.

So, you know, if you're starting to get low on your gas concentration, we have so many different things that tell us if that might be a possibility and tell us in plenty of time where we can prevent that. So, you know, as long as you're paying attention, which I do, I'm sitting there with you the whole time, I don't go anywhere. That's a non-issue really, I mean, it can happen, but not in an outpatient plastic surgery ASC, it can happen on a trauma patient or a cardiac patient who's having an open heart surgery. But even those cases are very rare. I can pretty much with a hundred percent positivity, tell those patients who've come to see me, that they will not have a recall, and they will not wake up during the surgery, not until it's time to wake up.

Dr. Bob Basu: So Dr. Firat, you've worked in some of the best hospitals in the Texas Medical Menter and around the country. And we're blessed to have you here do our anesthesia at our ambulatory surgery center. Can you tell our listeners, what is the difference between anesthesia services and then anesthesia care that's being done, say at a large hospital or a larger facility versus our state licensed ambulatory surgery center, at Basu Aesthetics?

Dr. Mary Ellen Firat: I think first of all, it's a lot more personal while we're here because there's not so many members of the teams. I mean, when you go to a hospital and you have surgery, you may get your anesthesiologist who may or may not have a CRNA. But what you really don't know is once you go to sleep, depending on certain shifts and when people are supposed to get off.

And if other cases arise, just because this person puts you to sleep, doesn't mean that person will stay in there with you. And as studies have shown, as people switch off during anesthesia, the more they switch off, the more potential for problems. I'm here with you from start to finish, I'm the one that talks to you before you come back, I'm the one that puts you to sleep. I'm the one that stays in there with you the entire time, and I'm the one that wakes you up. So that is important. In my opinion, I definitely would want that continuity of care. If I was having surgery and if one of my family members was having surgery, to me, that's the main difference.

And that's what I feel is one of the things that makes this surgery center unique is that our little team is always here and we don't go anywhere and it's continuity of care and makes for better patient care. I'm in there with you in the recovery room. I don't leave until the patient leaves. So that's the main difference.

And then of course you know, being at the state licensed ASC, we have everything I think I would need if I had to do anything to a patient as far as resuscitation it's right at my fingertips, which is wonderful. Whereas in a bigger hospital, sometimes there's different places for different things that you may need. And one person may not know where it is, but the other person who did is gone and it's just, to me, it just is so much easier and safer when you have exactly what you need and you have it close by. And that's, that's another one of the things I really like that the ASC is, is really unique and is unique here. And I'm very thankful for that.

Dr. Bob Basu: Our ambulatory surgery center, we only do aesthetic plastic surgery cases. So there's not, you know, GI cases. There's no orthopedics going on. So we really are sub-specialized just for the plastic surgery patient.

[00:09:00] So I'm going to move on to a question from another one of our listeners. We have a question from Teresa, from New Orleans. She's saying that “every time she's had surgery, she gets nauseous and she starts vomiting after every procedure she's had in the past. What can you do to help me not vomit after plastic surgery?”

Dr. Mary Ellen Firat: Well, that's something that I definitely don't want to happen. I myself have had history with nausea after surgery, and I try to take care of my patients like I would take care of my mom or a family member. I don't want anyone to throw up. Especially, you know, after a tummy tuck or something like that. So what we do, which I love is, and you've been a big part of this is we kind of go the extra mile in our anti-emetics. And we give to most patients a scopolamine patch behind the ear, which is wonderful. One that they put that on the night before, so that is a baseline of antiemetic in their system.

When they come in to see me the day of their surgery, and then I give at least four different antiemetics. I do. And I try to hit every one of the nausea producing centers in the brain. There's several different centers and each one has a specific medication that will counteract it. I try to do every one of those. And if we do have a patient who really has a significant history of post-op nausea and vomiting, regardless of the things that have been done in the past, we call them in a drug called Emend, which is one of the biggest guns in antiemetic therapy. We have, it's one of the things that's given to chemotherapy patients before they go in for their chemo, because it is so potent and we rarely, rarely, rarely have anyone even be nauseated here.

And I, I can count honestly, on one hand, the times out of thousands of cases that you and I have done together, that patients have thrown up. It is so rare and that makes me happy. And I've always, probably given a little more anti-emetic than most anesthesiologists, because I just don't want my patients to ever throw up. That's one of the most miserable feelings after surgery.

[00:11:00] Dr. Bob Basu: Right. Absolutely. One more question from our listeners, we have a question, uh, from Petra, from Austin, Texas. Petra states: “I've been thinking about a mommy makeover for a while. What's holding me back is I am absolutely scared about pain. What do you and Dr. Basu do to minimize pain after a tummy tuck surgery?”

Dr. Mary Ellen Firat: No one likes pain, that's for sure. And definitely don't want to have pain after a tummy tuck. You actually Dr. Basu are very helpful to me in that manner and that you kind of go above and beyond in giving your patients the Exparel, which is a long acting local anesthetic. For those of you out there who don't know, that lasts at least three days for most patients. And not only do you give it in the skin, you give it in the muscle. So there's, that's really important in a tummy tuck, is you want to anesthetize the muscle because that's what hurts after the surgery, it's not really the skin, it's the muscle pain.

And so when you do your Exparel blocks, I can tell immediately from the patient's vital signs, when they kick in, is everything just slows way down and then they do great recovery. I mean, I, again, I like an anti-emetic. We rarely, rarely have to get pain medicine in the recovery room. It's very rare because I definitely am not stingy with the pain medicine as well. I'm not one of those anesthesiologists who's more into the hypnotic and it's gonna give you so much of the gas, so to speak and not enough pain medicine.

I make sure you have pain medicine on board, more so than the hypnotic because the hypnotic wears off and then you're going to hurt. So again, I'm not stingy with my pain medicine and then with you, your Exparel. Well, and you know, not only on the tummy tucks, since you do it on your breast, sometimes on your GalaFLEX cases and not even the Exparel, just a half percent lidocaine with epi. I mean, all that, that you do really helps me. I can't take credit for all of that pain control for sure, because that's definitely helped by you, but yeah, we do our best and it's very rare patients complain of pain in recovery.

Dr. Bob Basu: Yeah. Like I started out the segment, you know, it, it really is a team effort to make sure our patients do well. And I always love telling patients, Dr.Firat's can be the best bartender you ever meet.

Dr. Mary Ellen Firat: I'm a pretty good bartender, I can promise you. There's no massive hanging over for my IV medicines too.

Dr. Bob Basu: So we often see patients that ask about, you know, anesthesia and they go to some other centers where their anesthesia is being done by a CRNA or a different professional, not necessarily an anesthesiologist. Should that concern them? And what are your thoughts about that?

Dr. Mary Ellen Firat: Kind of depends on the person. I personally would rather have an MD just because of the history of training and the knowledge base. And I would actually want to do some research on my MD if I could, before I got put to sleep again, you know, the, the less people involved in the care, it's less potential for error.

And then also, if you have one anesthesiologist who's staffing for CRNAs, which seems to be the norm these days, if your CRNA has a problem and the anesthesiologist is not available to help, you know, then you might have a little trouble because the CRNA might not have the knowledge base and may not be able to handle the complication that's occurring right now, because they are somewhere else with another patient who's having an issue. So to me, that's something to think about as well. And that's something most patients really don't think about.

Dr. Bob Basu: Right. They ask really good questions about who their surgeon is, and I'd love my listeners to remember that it's equally as important to understand who's doing your anesthesia. I'd love to take all the credit for our patients. Obviously, with this conversation, you see, we work as a team and I like to remind my patients that yeah, I'm definitely taking the plane off the ground. I might be your in-flight entertainment, but I can't land the plane without Dr. Firat. And so she's really critical to our team and I keep it simple when patients ask questions.

I mean, look, there are good CRNAs out there clearly. And there are good anesthesiologists out there, but I like to keep it very simple, the type of care that both Dr. Firat and I try to provide our patients is the same level of care that we would want for ourselves or our family members. And if I'm going to have surgery, I definitely want someone like Dr. Firat doing my anesthesia, cause I know her expertise and she's had extensive experience, doing much, much more complex cases than what we do here on healthy patients having elective cosmetic surgery. So I want to jump ahead now and talk a little bit about you. You work really hard. What do you like to do outside of work? How do you relax?

[00:16:00] Dr. Mary Ellen Firat: Oh my goodness. I'm probably so boring. I love to hang out at home with my family. We have a nice little spread of two acres and we have two big dogs and three cats. It's like one gigantic furry party at my house all the time. So just to say, we have a good time. So I enjoy that. I enjoy hanging out with my husband. We enjoy going out to dinner. I love to read. I'm a big book nerd and I'm old school. I want the actual book with pages. I can turn. I'd love that. Love is the thing. My family that's really it.

I, I used to love to travel, but you know, kind of in my older age, I've gotten to where I just want to be home. I want to be home and enjoy and hang out with my kids. And I'm blessed that I'm not too far away from here as well. So it's nice that even when we have long days and surgery, it's just a little scoot home and I can sit by the fire when it's chilly or sit outside and watch the kids run around. And, uh, yeah, I mean, that's it, that's it. I'm pretty easy to please.

[00:17:00] Dr. Bob Basu: Thank you. Thank you, Dr. Firat. You know, I think in summary, uh, for listeners in healthy patients, anesthesia is very safe, especially if you're being monitored by a board certified anesthesiologist and having your surgery and a. State licensed or fully accredited surgical facility.

So I want to thank Dr. Firat for joining us and answering some important questions that I'm sure a lot of listeners have about anesthesia. Whether they're thinking about plastic surgery or they have a loved one, that's going to have some other type of surgery. Anesthesia safety should be paramount. So thank you so much for sharing your insights.

Dr. Mary Ellen Firat: Thank you so much. And I just wanted to, I just wanted to add, you know, when I'm done before many of our patients ever have any specific concerns about anesthesia or want to talk to me, even in person pre-operatively, I'm happy to accommodate them. I'm happy to call them, talk to their family or even come in while they're here for their pre-op appointment. You know, just to kind of set their mind at ease, which I think helps a lot of people even before their surgery date. So anybody who has any questions please feel free to contact us and I'd be happy to talk to you guys about it. Thank you.

Announcer: Basu Aesthetics and Plastic Surgery is located in Northwest Houston in the Towne Lake area of Cypress. If [00:18:00] you'd like to be a guest or ask a question for Dr. Basu to answer on the podcast, go to basuplasticsurgery.com/podcast. On Instagram follow Dr. Basu and the team @basuplasticsurgery.

Behind the Double Doors is a production of The Axis.