Awake and aware while undergoing surgery

January 13, 2011

Awake and aware while undergoing surgery
Awake and aware while undergoing surgery

Fear of general anesthesia has propelled the growth of “Awake” surgery, which is surgery without general anesthesia. In such procedures Valium or Percocet may be used for initial relaxation and is then followed by infusions of lidocaine to anesthetize surgically-relevant body areas.

In the January 2011 issue of Self magazine, Sabrina Rubin Erdely reports that 38-year old Paulette Hacker underwent liposuction on her back, underarms, abdomen, hips and neck while awake and screaming at the Los Angeles Rodeo Drive office of Dr. Craig Alan Bittner. Following her surgery, which was performed by a physician’s assistant, Hacker’s entire body swelled to huge proportions even though she wore a postsurgical pressurized garment for eight weeks. Additionally, Hacker suffered from such severe neck and back pain that she couldn’t lift her daughter for a year and a half following surgery.

Awake proponents offer several selling points. First, since patients are awake, they can assert their rights while on the operating table. This provides the opportunity, for example, of selecting a “D” rather than a “C” cup breast augmentation while under the influence of Valium and Percocet. This is similar to making a decision while you are drunk. Their second selling point is that it makes sense to avoid general anesthesia, “which causes 1 death per 200,000 to 300,000 anesthetics given, according to a 2,000 estimate by the Institute of Medicine.” But, proponents neglect to mention that a lidocaine overdose can also kill. Awake advocates argue that a high lidocaine dose is safe because the anesthetic is injected into fat, which is slow to absorb it. Keith J. Ruskin, M.D., professor of anesthesiology at Yale retorts, “slow absorption could mean you’re just delaying peak toxicity. In other words, on the way home from surgery, complications like seizures and heart arrhythmias could arise.”

Hacker learned that in three other Bittner patients, liposuction was performed by Bittner’s office manager who was also his girlfriend. After $6,000 worth of pain-relieving hyperbaric and chiropractic treatment, Hacker has “been left with a lumpy back, a misshapen belly, uneven hips, a neck striated with scar tissue, an asymmetrical jawline and a conga line of polka-dot scars down her sides.”

Because there are scant regulations preventing doctors from performing procedures for which they have no expertise, consumers beware. Make sure the doctor performing your liposuction is certified by the American Board of Plastic Surgery. Make sure your procedure is performed in a facility that is accredited by an agency such as the Accreditation Association for Ambulatory Healthcare. Check to make sure that the procedure you undergo has been clinically proven.

The mission of the American Society for Aesthetic Plastic Surgery (ASAPS) includes medical education, public education and patient advocacy. Plastic Surgery News Briefs are summaries of current stories found through various news and magazine outlets that relate to or mention plastic surgery and cosmetic procedures. The views expressed in these news articles do not necessarily reflect the opinions of ASAPS, but are merely published as an educational service to our members and the general public. For additional information on these subjects and other plastic surgery related topics, please go to

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The American Society for Aesthetic Plastic Surgery (ASAPS), is recognized as the world's leading organization devoted entirely to aesthetic plastic surgery and cosmetic medicine of the face and body. ASAPS is comprised of over 2,600 Plastic Surgeons; Active Members are certified by the American Board of Plastic Surgery (USA) or by the Royal College of Physicians and Surgeons of Canada and have extensive training in the complete spectrum of surgical and nonsurgical aesthetic procedures. International Active Members are certified by equivalent boards of their respective countries. All members worldwide adhere to a strict Code of Ethics and must meet stringent membership requirements.


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