Anaesthesia and Cosmetic Surgery In Focus

Cosmetic surgery is often thought as an industry rather than a surgical speciality.

Documentations of cosmetic surgery can be traced as far back as Ancient Egypt, however it wasn’t until 1815 that the first major plastic surgery was performed in the Western world.

Joseph Constantine Carpue spent 20 years in India studying the rhinoplasty techniques that local physicians had been practising for hundreds of years. Although Carpue might have broken new ground at the time, it took nearly a hundred years and a major global conflict for cosmetic surgery to take its next major step forward.

Sir Harold Gillies, a New Zealand-born otolaryngologist, is considered to be the modern father of plastic surgery. Working in London during World War I, Gillies was able to pioneer several new cosmetic surgery techniques to help soldiers suffering from disfiguring facial injuries. Gillies’ first reported success story is thought to be a facial flap surgery on a sailor injured during the Battle of Jutland.

Walter Yeo (pictured, left) was injured whilst manning the guns aboard the HMS Warspite, he suffered severe facial injuries including the loss of his upper and lower eyelids. Although Yeo was unfortunate in Battle he was lucky enough to receive the first skin flap surgery from Gillies; after 2 years of testing and surgery he was returned to active duty and eventually lived to the age of seventy.

Flash forward to today and cosmetic surgeries are more associated with body image and celebrity lifestyles than war heroes. Problems related to anaesthesia have more often than not captured the public’s attention in the last few years. Both Michael Jackson and Joan Rivers, both of whom were somewhat notorious for their brazen use of cosmetic surgery, died due to overdoses of propofol and this has fed into the growing suspicion of the use of the use of general anaesthetics.

The umbrella term of cosmetic surgery is a large one and encompasses far more than just the voluntary procedures thousands undergo each year to change their appearance.

The technical definition of cosmetic surgery is the speciality involving the restoration, reconstruction or alteration of human body. So, whilst procedures such as breast reduction surgery and liposuctions are still common place in the UK (despite these kinds of procedures dropping in popularity over the last two years), it’s important to remember that many cosmetic surgeries take place as a result of a prior existing condition.

As cosmetic surgeries so often involve incisions that require aggressive action on the part of the surgeon, it’s commonplace for the patient to be put under general anaesthetic. It’s not uncommon for patients to feel somewhat uneasy before going under general anaesthetic; these initial fears can be related to any number of things including: a presumption of an allergic reaction and the patient’s fear that they will not wake up again.

Despite these fears it’s crucial to remember that complications from general anaesthetics are rare in the UK, occurring in less than 1 in 10,000 cases – any issues that do occur are usually as a result of the history of the patient.

A Short History of Anaesthesia

It might surprise (and perhaps worry you) to find out that the exact science of Anaesthesia is still very much a mystery to the scientific world.

Before the establishment of anaesthetics as we know them today, going under the knife was a stressful and painful experience.

Although archaeological studies have revealed that ancient civilisations have long understood the effects of plants such as the opium poppy, the use of anaesthetic in surgical situations was not properly implemented until the 16th Century. Before then patients would be lucky to imbibe a strong alcoholic drink or perhaps a dose of opium; so, not surprisingly, the idea of going under the knife wasn’t a very attractive prospect!

The earliest records of scientifically tested anaesthesia came from China in the 3rd Century. Hua Tuo is credited as the first physician to use an anaesthetic in a surgery. His wine and herb concoction, known as ‘Mefisan’ was reportedly used to perform internal surgery, however the recipe to this drug was lost to the ages. Throughout the 9th-13th Century more alternatives of anaesthesia began to crop up including mixtures of opium, mandrake and hemlock.

The first recorded scientific breakthrough of a medically sound anaesthesia came in 1549 when German botanist Velrius Cordus created the first form of ether by distilling ethanol and sulphuric acid. A hundred years later, Robert Boyle innovated intravenous injections of opium using body parts from geese and dogs.

The following centuries brought with them further incredible discoveries that facilitated the development of modern anaesthesia as we know it today. Priestley’s isolation of oxygen proved key in providing the next step in the process for Humphry Davy who wrote how ‘nitrous oxide in its extensive operation appears capable of destroying physical pain, it may probably be used with advantage during surgical operations in which no great effusion of blood takes place.’

The discovery of morphine just a few years later would completely change the way surgeons could operate on their patients, however the early innovations were not without their occasional setbacks.

As you could imagine, during the earliest days of chloroform and ether use, doses were often miscalculated leading to the deaths of unfortunate patients. Many combinations of anaesthetics were later discovered to be physically damaging to the body, such as the link discovered between nephrotoxicity and methoxyflurane. But it wasn’t just overdoses that made this new field of anaesthesiology so dangerous; amongst other things there were a raft of chemical explosions and fires across the United States during the 20th Century, as a result of the hasty introduction of unstable chemicals into hospitals.

Flash forward to today and although we might have learnt a thing or two about storing our chemicals, the truth is that the actual science behind how anaesthetics actually work is still mostly unknown. Theories have been posited by scientists from many disciplines, however there remains no definitive answer as to how we millions of people are kept in a state of blissful, painless ignorance every year.

Whilst this might sound rather worrying, the truth is that modern anaesthesiology is based on centuries of research and rigorous testing – the important thing to remember is that it works.