September is a busy conference month for Mr Pacifico - at the beginning of the month he will be going to the biennial conference of…
The Coronavirus pandemic will have changed life for all of us in recent times. Surgery and medicine are at the forefront of its impact. Specifically, this will have had a significant impact on aesthetic surgery. Aesthetic surgery is elective surgery – therefore it needs to be as safe as possible and, in this case, we need to minimise the risk of lung complications and other potential COVID related side effects.
Bearing this in mind I have been having numerous conversations with colleagues, both surgeons and anaesthetists, about how we can maximise the safety of my patients in the future, once elective surgery can start up again.
One very promising approach is to reduce the number of patients having general anaesthetic procedures, making more use of sedation and local anaesthetic. This is something we already do for a variety of procedures, so we have a lot of experience with it. Therefore, extending its use to more procedures is something we are very comfortable with in the future.
For example, in the same way as caesarean sections are performed with spinal anaesthesia, we could perform tummy tucks in a similar way. We already perform local anaesthetic facelifts for less invasive approaches, so adding sedation will help us to perform more extended and involved facelifts in a safe and comfortable environment. Finally, breast surgery is an area that we can perform under local anaesthesia with sedation by combining the use of local anaesthetic with “regional nerve blocks” where some of the main nerves that provide sensation to the breast are targeted by specific injections.
Whilst these approaches may add some time to the procedures, they might help increase the safety profile with respect to COVID-19, and therefore I feel that this is an approach well worth considering. Every case will be reviewed on an individual basis, and the best overall plan made for each of my patients.
Exactly how we will be doing things moving forwards is still uncertain. We have the advantage of watching how other countries are starting back up – from Europe to the US, so we will be able to learn what works (and what doesn’t) from them.
Coronavirus testing will inevitably be crucial – when quick results turnaround testing becomes more widely available it will be transformational. Prospective surgical patients will be tested (and isolated as appropriate between testing and results) but also staff will need to be tested on a regular basis to ensure they are not asymptomatic carriers of the disease.
I am sure testing like this will become routine in due course, but again, I don’t yet know when.
So, there does seem to be some light at the end of the tunnel, but we should not be too hasty in getting back to elective surgery until we are as confident as we can be about minimising risks to our patients and the healthcare staff.