Twilight Sedation vs.General Anesthesia for Lumpectomy/Nodes

Hi Rushin,

I had a lumpectomy with a twilight at Kaiser. It's interesting because I saw surgeons at two different Kaiser facilities in the same general area but with different administrators, with one using the general anesthetic and the other, twilight. When I asked why the two facilities differed, I was told by the one using twilight that it was a matter of preference--they felt a general wasn't needed, while the other facility apparently thought differently. I thought the twilight option was great & had no problems--actually couldn't remember a thing (forgot the name of the drug used which wipes out your memory temporarily). Hope this helps!

Also, you might consider a third opinion (I had four). The first doctor I saw was a surgeon (their protocol), who led me to believe that in addition to lumpectomy, I would have the six weeks of radiation and 5 years, drugs. I'm not sure whether in subsequent visits with radiologist, etc., they would have recommended a different course, because I opted not to go forward with that surgeon. She also didn't distinguish my type of IDC (tubular), which studies indicate may not have to be treated as aggressively. I'm sure I would have been over treated had I stayed with her. I ended up declining radiation (newer team was okay with that)-- and also declined recommended meds--. This was just my personal decision based on my dx and what I felt I could and could not deal with in terms of drug-related side-effects, etc.

My mom was 85 when she had a lumpectomy, and a full course of radiation, and she did fine with it. She had high blood pressure but not any other major health issues. Same with me, but I'm a bit younger. Lumpectomies don't take long and the patient isn't out very long.

The problem with twilight is the patient can flinch and twitch, which could cause major problems for the surgeon. I had a large benign growth on my neck removed three years ago, and the surgeon was originally going to do twilight, but changed his mind after assessing that the lipoma was too close to my jugular to take any chances.

Hi, Rushin,

I know every place is different, but where I went, the anesthesiologists made the call (I.e. I wanted local for port and surgeon was fine, but not anesthesiologist said no. So it goes). A few years ago, I had to have spine surgery and remembered how nice the anesthesiologist was to my husband for an outpatient procedure. I asked for him, and he was very, very happy to talk and help. He said he really was honored to be called on in particular and many people don’t know they can ask to speak to a member of their anesthesiology staff. No guarantees you’ll get that particular person, but it may be good to ask. I wish the best for you and your mom!

Dee

The kind of anesthesia and the amount of pain relief can be relevant to outcome including recurrences. You want to make sure of this. Certain anesthesia practices have better and worse stats regarding metastases later. Here is one article, I can't find the other one I had found... I called the anesthesiologist and asked specifically before my surgery what he planned to use. I think calling the anesthesiologist is rare because he seemed thrilled to be called!

https://foodforbreastcancer.com/amp/articles/morphine-during-surgery-increases,-whereas-toradol-reduces,-risk-of-metastasis

You said that your mother's fear of anesthesia partially stems from an experience her own mother had 20 years ago. Anesthetics have changed tremendously in the past 20 years. I can remember being aware of going to sleep and crawling out of the anesthesia after the surgery. The ones I've had in the last couple of years have not been like that at all. Before I know it, I'm asleep, and I wake up not feeling spaced out like I used to. 

Had one but lost it... It was more detailed. NSAIDs and lidocaine and one specific anesthesia were considered best.

Here is a nih article about it that I just found. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5649999/