Anesthetic Principles

Advances in anesthesia have expanded the field of plastic surgery by allowing more procedures to be done, while also increasing the safety of the patient. Anesthesia is a spectrum ranging from local anesthetic injected by the surgeon, to regional and neuraxial blocks or general anesthesia with an anesthesia team. Anesthesiologists work with the surgeon to assess a patient’s preoperative risk and make joint decisions to determine if additional medical optimization is needed prior to surgery. New peripheral blocks allow alternatives to general anesthesia or serve as adjuncts to improve post-operative pain. Selection of drugs used to induce and maintain anesthesia are changing with the advent of Enhanced Recovery After Surgery Protocols and emphasis on decreasing opioids. Teamwork and excellent communication are imperative to navigate anesthetic and surgical emergencies.  This review contains 3 figures, 4 tables, and 29 references. Keywords: sedation, general anesthesia, regional anesthesia, peripheral nerve blocks, local anesthetic toxicity syndrome, ASA physical status, preoperative fasting guidelines, opioids, multi-modal analgesia, ERAS, crisis checklists