General anesthesia is the type of anesthesia that is used during FTM top surgery. General anesthesia is a medication that puts you into a deep sleep so that you are not aware of the surgery. It is also used to block pain and prevent movement during the surgery.

There are two main types of general anesthesia:

  • Intravenous (IV) anesthesia: This is the most common type of general anesthesia. The medication is given through an IV in your arm or hand.
  • Inhalational anesthesia: This type of anesthesia is given through a mask that you wear over your nose and mouth. The medication is inhaled into your lungs.

The type of general anesthesia that is used will depend on your individual needs and preferences. Your surgeon will discuss the options with you before surgery.

General anesthesia is a safe and effective way to provide anesthesia for FTM top surgery. However, there are some risks associated with general anesthesia, including:

  • Allergic reaction: In rare cases, people can have an allergic reaction to the anesthesia medication.
  • Respiratory problems: The anesthesia medication can suppress your breathing. This is why it is important to have a qualified anesthesiologist present during surgery.
  • Nausea and vomiting: Some people experience nausea and vomiting after general anesthesia.

The risks of general anesthesia are generally outweighed by the benefits. General anesthesia allows you to have a safe and comfortable surgery without feeling any pain.

If you are considering FTM top surgery, it is important to talk to your surgeon about the risks and benefits of general anesthesia. Your surgeon can help you decide if general anesthesia is right for you.

FTM top surgery is typically performed under general anesthesia. General anesthesia ensures that you are completely unconscious and pain-free throughout the entire surgical procedure. It allows the surgeon to perform the surgery safely and ensures your comfort during the operation.

Under general anesthesia, an anesthesiologist or a certified nurse anesthetist administers medications that induce a controlled state of unconsciousness. These medications are typically delivered through an intravenous (IV) line, and in some cases, an inhaled anesthetic may be used as well. The anesthesiologist monitors your vital signs, including heart rate, blood pressure, oxygen levels, and breathing, throughout the procedure to ensure your safety and adjust the anesthesia as needed.

General anesthesia provides a temporary state of unconsciousness and amnesia, allowing the surgeon to perform the surgery without causing pain or discomfort. It also enables you to have a consistent level of anesthesia throughout the entire procedure, ensuring you are unaware and do not feel any pain.

Before your surgery, the anesthesiologist will review your medical history, perform a pre-anesthetic evaluation, and discuss the anesthesia plan with you. They will consider factors such as your overall health, any medications you are taking, and any allergies you may have to determine the most appropriate anesthesia approach for you.

It’s important to disclose any relevant medical information, including previous experiences with anesthesia, to the anesthesia team during your pre-operative consultations. This will help them tailor the anesthesia plan to your specific needs and ensure your safety and comfort during the surgery.

Female-to-male (FTM) top surgery, also known as chest masculinization surgery or chest reconstruction surgery, typically involves the removal of breast tissue to create a more masculine chest contour. The type of anesthesia used during FTM top surgery may vary depending on factors such as the surgeon’s preference, the specific surgical technique employed, and the patient’s health.

Generally, FTM top surgery can be performed under either general anesthesia or local anesthesia with sedation.

  1. General Anesthesia: In this approach, the patient is completely unconscious and does not feel any pain during the surgery. General anesthesia is administered through intravenous drugs and inhaled gases, and the patient is carefully monitored throughout the procedure.
  2. Local Anesthesia with Sedation: Some surgeons may opt for local anesthesia with sedation. In this case, the patient is given a local anesthetic to numb the chest area, and sedative drugs are administered to induce a state of relaxation. While the patient may be conscious, they are likely to be in a relaxed and drowsy state and may not feel pain during the surgery.

The choice between general anesthesia and local anesthesia with sedation is often based on the surgeon’s experience, the patient’s medical history, and the complexity of the procedure. It’s essential for patients to discuss their preferences and any concerns they may have about anesthesia with their surgeon during the preoperative consultation.

It’s important to note that medical practices and techniques may evolve, so individuals should consult with their surgeon for the most up-to-date information regarding anesthesia options for FTM top surgery.

General Anesthesia

General anesthesia is a medical state induced in a patient to make them unconscious and insensitive to pain during surgical procedures or other medical interventions. It involves the administration of medications that affect the central nervous system and produce a reversible loss of consciousness.

Here are the key components and details of general anesthesia:

  1. Induction: This is the initial phase where the patient is transitioned from consciousness to unconsciousness. It is typically achieved through the administration of intravenous medications or inhaled anesthetics. The choice of drugs may depend on the patient’s health, the type of surgery, and the preferences of the anesthesia team.
  2. Maintenance: Once the patient is unconscious, the anesthesia is maintained to keep them in a state of deep sleep throughout the surgical procedure. This may involve a combination of intravenous drugs and inhaled gases. The anesthesia team closely monitors the patient’s vital signs, such as heart rate, blood pressure, and oxygen levels, to ensure their well-being.
  3. Analgesia (Pain Control): General anesthesia not only induces unconsciousness but also provides pain relief. This is crucial during surgery to ensure the patient does not feel pain. Analgesic medications are often administered in conjunction with the anesthetic agents.
  4. Muscle Relaxation: To facilitate surgical procedures and prevent involuntary movements, muscle relaxants may be administered. These drugs temporarily paralyze certain muscles, making it easier for the surgical team to perform procedures.
  5. Monitoring: Throughout the entire process, the patient’s vital signs and physiological parameters are closely monitored by the anesthesia team. This includes continuous monitoring of heart rate, blood pressure, oxygen saturation, and other relevant parameters.
  6. Reversal: Once the surgical procedure is completed, the administration of anesthetic agents is stopped, and the patient is allowed to wake up. In some cases, medications can be administered to reverse the effects of muscle relaxants and hasten the recovery process.
  7. Recovery: After the surgery is complete, the patient is moved to a recovery area where they are monitored as they wake up from anesthesia. The anesthesia team continues to manage any postoperative pain and ensures the patient’s comfort during the recovery phase.

It’s important to note that general anesthesia is a complex medical intervention that requires careful assessment of the patient’s health, individualized planning, and vigilant monitoring by trained anesthesia professionals to ensure a safe and effective experience.

Intravenous (IV) anesthesia

Intravenous (IV) anesthesia is a medical practice that involves the administration of anesthetic agents directly into the bloodstream through a vein. This method is widely used in various medical and surgical procedures to induce and maintain anesthesia or sedation. IV anesthesia allows for precise control over the depth of anesthesia, offers a rapid onset of action, and facilitates a smoother recovery. This detailed exploration will cover the key aspects of IV anesthesia, including the medications used, the process of administration, types of anesthesia, monitoring, and post-procedure recovery.

Medications Used in IV Anesthesia:

  1. Induction Agents:
  • Propofol: A commonly used induction agent known for its rapid onset and short duration of action. It induces unconsciousness quickly, making it suitable for various surgical procedures.
  • Etomidate: Another induction agent that provides a quick and smooth transition to anesthesia with minimal impact on cardiovascular and respiratory systems.
  • Barbiturates: Although less commonly used today, barbiturates like thiopental were historically employed for induction.
  1. Sedatives:
  • Midazolam: A benzodiazepine commonly used for its sedative and anxiolytic properties. It promotes relaxation and amnesia, making it valuable in procedural sedation.
  • Diazepam: Another benzodiazepine with sedative properties, though its longer duration of action may limit its use in certain settings.
  1. Analgesics:
  • Opioids: Fentanyl, morphine, and other opioids are often used for pain management during and after procedures. They provide effective analgesia and help ensure patient comfort.
  • Ketamine: In addition to its dissociative anesthetic effects, ketamine has analgesic properties and is used in certain situations, especially for patients with chronic pain.

Process of Administration:

  1. Accessing the Vein:
    • A peripheral intravenous (IV) line is typically inserted into a vein, often in the arm or hand. In more complex cases, a central venous catheter may be used for larger surgeries.
  2. Drug Delivery:
    • Anesthetic medications are then administered through the IV line. The choice and combination of drugs depend on factors such as the type and duration of the procedure, the patient’s health status, and the preferences of the anesthesia team.
  3. Titration and Control:
    • Anesthesia providers carefully titrate the medications based on the patient’s response, ensuring the desired level of sedation or anesthesia is achieved and maintained throughout the procedure.

Types of Anesthesia with IV Administration:

  1. Sedation:
    • Minimal Sedation: Produces a relaxed and calm state. The patient remains conscious and can respond to verbal stimuli.
    • Moderate Sedation/Conscious Sedation: Induces a deeper state of relaxation, often resulting in decreased responsiveness. However, the patient can still be aroused with verbal or tactile stimulation.
  2. General Anesthesia:
    • In cases requiring complete unconsciousness, higher doses of IV anesthetic agents are administered. This renders the patient insensible to pain and unconscious throughout the procedure.

Monitoring during IV Anesthesia:

  1. Vital Signs Monitoring:
    • Continuous monitoring of vital signs is paramount, including heart rate, blood pressure, respiratory rate, and oxygen saturation. Electrocardiogram (ECG) monitoring provides information about the heart’s electrical activity.
  2. End-Tidal Carbon Dioxide (EtCO2) Monitoring:
    • Measurement of exhaled carbon dioxide levels helps assess the adequacy of ventilation and the patient’s respiratory status.
  3. Depth of Anesthesia Monitoring:
    • Various technologies, such as bispectral index (BIS) monitoring, may be used to assess the depth of anesthesia and help prevent awareness during surgery.
  4. Temperature Monitoring:
    • Continuous monitoring of body temperature is crucial, especially during longer procedures, to prevent hypothermia.

Benefits of IV Anesthesia:

  1. Rapid Onset:
    • IV administration allows for a quick onset of anesthesia, enabling efficient induction and timely initiation of the surgical procedure.
  2. Precise Control:
    • Anesthesia providers can easily titrate the medications to achieve the desired level of sedation or anesthesia, providing precise control over the patient’s state.
  3. Reversibility:
    • Some IV anesthetic agents have reversal agents, allowing for rapid recovery and a smoother transition to wakefulness.
  4. Reduced Inhalation Anesthetic Use:
    • For certain procedures, IV anesthesia may reduce the need for inhaled anesthetics, which can be advantageous in specific patient populations.

Post-Procedure Recovery:

  1. Discontinuation of Anesthetic Agents:
    • Once the surgical procedure is complete, the administration of IV anesthetic agents is stopped.
  2. Recovery Monitoring:
    • The patient is carefully monitored during the recovery phase, with a focus on assessing consciousness, respiratory status, and pain levels.
  3. Reversal Agents (if applicable):
    • Reversal agents may be administered to counteract the effects of certain drugs and expedite the recovery process.
  4. Transfer to Recovery Area:
    • Depending on the type of procedure and the patient’s condition, they may be transferred to a post-anesthesia care unit (PACU) or a designated recovery area.
  5. Postoperative Pain Management:
    • Analgesic medications, including opioids and non-opioid options, are often provided to manage postoperative pain.

Considerations and Precautions:

  1. Patient Assessment:
    • A thorough preoperative assessment is conducted to evaluate the patient’s medical history, allergies, and overall health status.
  2. Individualized Approach:
    • The anesthesia plan is tailored to each patient, considering factors such as age, weight, comorbidities, and the nature of the procedure.
  3. Patient Communication:
    • Clear communication between the anesthesia team and the patient is crucial. In cases of sedation, patients may be able to respond to verbal cues during the procedure.
  4. Safety Protocols:
    • Strict safety protocols are followed to minimize the risk of complications and ensure patient well-being.


Intravenous anesthesia is a versatile and widely utilized approach in modern medicine, offering benefits such as rapid onset, precise control, and a range of options for different levels of sedation or anesthesia. The careful selection and administration of medications, coupled with vigilant monitoring, contribute to the safety and effectiveness of IV anesthesia. The individualized approach to patient care, consideration of specific procedural requirements, and ongoing advancements in anesthesia techniques continue to enhance the overall experience and outcomes for patients undergoing surgery or medical procedures. As medical practices evolve, the use of IV anesthesia remains a cornerstone in ensuring the comfort and safety of patients in diverse clinical settings.


Inhalational anesthesia

Inhalational anesthesia is a medical technique that involves the administration of anesthetic agents through inhalation to induce and maintain a state of general anesthesia or sedation during surgical procedures. This method utilizes gases or vapors that are inhaled by the patient, leading to a reversible loss of consciousness and sensation. Inhalational anesthesia has been a fundamental component of surgical care for many years, and its use continues to evolve with advancements in technology and safety measures. In this comprehensive exploration, we will delve into the key aspects of inhalational anesthesia, including the types of anesthetic agents used, the process of administration, modes of delivery, monitoring, and considerations for patient safety.

Types of Inhalational Anesthetic Agents:

  1. Nitrous Oxide (N2O):
  • Nitrous oxide, commonly known as “laughing gas,” is a colorless and odorless gas used as a weak anesthetic. It is often employed in combination with other inhalational or intravenous agents to enhance their effects.
  1. Inhalational Anesthetics:
  • Desflurane: A volatile liquid inhalational anesthetic with a low blood-gas solubility, allowing for rapid onset and offset of anesthesia. It is commonly used in surgical procedures, particularly those requiring a quick recovery.
  • Sevoflurane: Another volatile liquid inhalational anesthetic known for its smooth induction and recovery characteristics. It is widely used in both adult and pediatric patients for various surgical interventions.
  • Isoflurane: An inhalational anesthetic with a pleasant odor, commonly used for general anesthesia. It provides good muscle relaxation and is suitable for longer procedures.

Administration of Inhalational Anesthesia:

  1. Vaporizers:
  • Inhalational anesthetics are typically administered using vaporizers, which convert liquid anesthetic agents into a vapor that can be inhaled. Vaporizers allow for precise control of the concentration of anesthetic delivered to the patient.
  1. Delivery Systems:
  • Anesthesia Machines: These machines facilitate the delivery of a controlled mixture of gases and anestheticvapors to the patient. They include features such as vaporizers, breathing circuits, and monitors.
  • Breathing Circuits: These are systems that connect the patient to the anesthesia machine, allowing the inhalation of the anesthetic gases and removal of carbon dioxide.
  1. Mask Induction:
  • In certain cases, particularly with pediatric patients or those who may find intravenous access challenging, inhalational anesthesia can be initiated using a mask for induction.
  1. Endotracheal Intubation:
  • For more controlled ventilation and airway management, a breathing tube (endotracheal tube) may be inserted into the patient’s trachea during induction.

Modes of Delivery:

  1. Open Circuit:
  • In an open circuit system, the exhaled gases are not recirculated. They are released into the environment or captured by a scavenging system. Nitrous oxide is often used in open circuits.
  1. Closed Circuit:
  • Closed circuit systems are more efficient in conserving anesthetic gases. Exhaled gases are recirculated, and carbon dioxide is removed. This is particularly beneficial for volatile anesthetics like desflurane.

Monitoring during Inhalational Anesthesia:

  1. Vital Signs Monitoring:
  • Continuous monitoring of vital signs, including heart rate, blood pressure, respiratory rate, and oxygen saturation, is essential to ensure patient safety during anesthesia.
  1. End-Tidal Carbon Dioxide (EtCO2) Monitoring:
  • Measurement of exhaled carbon dioxide levels provides valuable information about the adequacy of ventilation and the patient’s respiratory status.
  1. Inspired and Expired Gas Concentrations:
  • Monitoring the concentrations of inhaled and exhaled anesthetic gases helps maintain the desired depth of anesthesia and assess the patient’s response.
  1. Anesthetic Gas Analyzers:
  • These devices measure the concentration of specific anesthetic gases in the breathing circuit, aiding in the precise control of anesthesia.
  1. Neuromuscular Monitoring:
  • Monitoring devices, such as train-of-four (TOF) monitors, may be used to assess the degree of neuromuscular blockade in patients receiving muscle relaxants.

Benefits of Inhalational Anesthesia:

  1. Precision and Control:
  • Inhalational anesthetics provide precise control over the depth of anesthesia. The concentration of the anesthetic gases can be adjusted easily to match the patient’s needs.
  1. Versatility:
  • Inhalational anesthesia is versatile and applicable to a wide range of surgical procedures, from short outpatient surgeries to complex, lengthy interventions.
  1. Smooth Induction and Emergence:
  • Volatile anesthetics like sevoflurane and desflurane offer a smooth induction and emergence from anesthesia, contributing to a more pleasant experience for the patient.
  1. Minimal Metabolism:
  • These agents are minimally metabolized by the body, contributing to predictable and controllable pharmacokinetics.

Considerations and Precautions:

  1. Environmental Impact:
  • The release of anesthetic gases into the environment, particularly nitrous oxide, has raised environmental concerns. Scavenging systems help minimize environmental impact.
  1. Respiratory Depression:
  • Inhalational anesthesia can depress respiratory function. Continuous monitoring and adjustment of ventilation parameters are crucial to prevent respiratory complications.
  1. Avoidance in Certain Patient Populations:
  • Some patients, such as those with a history of malignant hyperthermia or certain genetic conditions, may be more susceptible to adverse effects of inhalational anesthetics.
  1. Maintenance of Airway:
  • Adequate airway management is crucial during inhalational anesthesia. Endotracheal intubation or the use of supraglottic airway devices may be employed to maintain a clear airway.

Post-Procedure Recovery:

  1. Elimination of Anesthetic Gases:
  • After the procedure, the elimination of residual anesthetic gases is facilitated through effective ventilation and the use of scavenging systems.
  1. Reversal of Neuromuscular Blockade:
  • If muscle relaxants were used, reversal agents may be administered to restore normal muscle function.
  1. Post-Anesthesia Care Unit (PACU) Monitoring:
  • Patients are closely monitored in the PACU as they emerge from anesthesia. Vital signs, respiratory status, and overall well-being are carefully assessed.
  1. Pain Management:
  • Postoperative pain management is addressed using a combination of analgesic medications, including opioids and non-opioid options.


Inhalational anesthesia remains a cornerstone in the field of anesthesia, providing a reliable and controllable method for inducing and maintaining a state of general anesthesia or sedation. The continuous evolution of inhalational anesthetic agents, delivery systems, and monitoring technologies has enhanced patient safety and outcomes. The versatility of inhalational anesthesia, its smooth induction and emergence characteristics, and the ability to precisely control the depth of anesthesia contribute to its widespread use across various surgical specialties. As medical practices advance, the thoughtful consideration of patient characteristics, environmental impact, and continuous improvements in safety measures will further refine the role of inhalational anesthesia in modern healthcare. This method continues to play a crucial role in ensuring the comfort, safety, and success of surgical interventions


Local Anesthesia with Sedation

Local anesthesia with sedation is a medical approach commonly used to provide pain relief and induce a relaxed, drowsy state during surgical or medical procedures. This combination of local anesthesia and sedation is particularly beneficial for patients who need to remain conscious but comfortable throughout a procedure. In this comprehensive exploration, we will delve into the key aspects of local anesthesia with sedation, including the types of medications used, the administration process, the levels of sedation, monitoring techniques, and the post-procedure recovery phase.

Medications Used in Local Anesthesia with Sedation:

  1. Local Anesthetics:
  • Lidocaine: A frequently used local anesthetic, lidocaine works by blocking nerve signals in the targeted area, preventing the sensation of pain. It is commonly used for various procedures, including dental work and minor skin surgeries.
  1. Sedative Medications:
  • Midazolam: A benzodiazepine often used for its sedative and anxiolytic properties. It induces a relaxed and drowsy state, contributing to patient comfort during the procedure.
  • Propofol: Although primarily used for induction during general anesthesia, it can also be used for moderate sedation in combination with local anesthesia.
  1. Analgesics:
  • Opioids (e.g., Fentanyl): These medications provide pain relief and contribute to the overall sedative effect. Opioids may be used to manage pain during and after the procedure.

Administration Process:

  1. Local Anesthesia:
  • A local anesthetic, such as lidocaine, is administered to numb the specific area where the procedure will take place. This is typically done through injections near nerve endings, blocking pain signals.
  1. Sedation:
  • Sedative medications, such as midazolam or propofol, are administered to induce a relaxed and drowsy state. The goal is to keep the patient comfortable and alleviate anxiety without rendering them completely unconscious.
  1. Continuous Monitoring:
  • Throughout the procedure, the patient’s vital signs, including heart rate, blood pressure, respiratory rate, and oxygen saturation, are continuously monitored to ensure safety and well-being.
  1. Communication with the Patient:
  • In many cases, patients under local anesthesia with sedation can still communicate with the surgical team. This allows them to provide feedback on any discomfort or sensations they may be experiencing.

Levels of Sedation:

  1. Minimal Sedation:
  • The patient is in a relaxed state but remains fully conscious and responsive. Minimal sedation is often used for procedures where anxiety reduction is the primary goal.
  1. Moderate Sedation (Conscious Sedation):
  • The patient is in a deeper state of relaxation, with decreased responsiveness. However, they can still be easily aroused and respond to verbal or light tactile stimulation. This level of sedation is commonly used for more invasive or lengthy procedures.

Monitoring Techniques:

  1. Vital Signs Monitoring:
  • Continuous monitoring of vital signs is crucial to assess the patient’s cardiovascular and respiratory status. This includes heart rate, blood pressure, respiratory rate, and oxygen saturation.
  1. Electrocardiogram (ECG) Monitoring:
  • ECG monitoring provides information about the electrical activity of the heart, ensuring that any cardiac issues are promptly identified and addressed.
  1. End-Tidal Carbon Dioxide (EtCO2) Monitoring:
  • Measurement of exhaled carbon dioxide levels helps evaluate the adequacy of ventilation and respiratory function.
  1. Oxygen Administration:
  • Supplemental oxygen may be provided to ensure adequate oxygenation, especially in cases where the patient’s breathing may be compromised.
  1. Sedation Level Assessment:
  • The anesthesia team regularly assesses the level of sedation to ensure it aligns with the intended depth. This assessment helps prevent over-sedation or inadequate sedation.

Benefits of Local Anesthesia with Sedation:

  1. Patient Comfort:
  • Combining local anesthesia with sedation enhances patient comfort by eliminating pain and reducing anxiety during the procedure.
  1. Reduced Anxiety:
  • Sedative medications contribute to anxiety reduction, creating a more relaxed and positive experience for the patient.
  1. Avoidance of General Anesthesia Risks:
  • Local anesthesia with sedation allows certain procedures to be performed without the need for general anesthesia, reducing the associated risks and potential side effects.
  1. Quicker Recovery:
  • The absence of general anesthesia often leads to a faster recovery time, allowing patients to return to normal activities sooner.

Considerations and Precautions:

  1. Patient Assessment:
  • A thorough preoperative assessment is conducted to evaluate the patient’s medical history, allergies, and overall health status.
  1. Individualized Approach:
  • The anesthesia plan is tailored to each patient, considering factors such as age, weight, comorbidities, and the nature of the procedure.
  1. Airway Management:
  • While the patient is not completely unconscious, maintaining a clear airway is essential to ensure proper ventilation and oxygenation.
  1. Reversibility:
  • Sedative medications used, such as midazolam, have reversal agents (e.g., flumazenil) that can be administered to rapidly reverse their effects if necessary.

Post-Procedure Recovery:

  1. Discontinuation of Sedation:
  • Once the procedure is complete, the administration of sedative medications is stopped, allowing the patient to gradually return to full consciousness.
  1. Recovery Monitoring:
  • The patient is closely monitored during the recovery phase, assessing vital signs, level of consciousness, and overall well-being.
  1. Pain Management:
  • Analgesic medications, including opioids and non-opioid options, are often provided to manage postoperative pain.
  1. Post-Anesthesia Care Unit (PACU):
  • Depending on the nature of the procedure and the patient’s condition, they may be transferred to a PACU for further observation before being discharged.


Local anesthesia with sedation is a valuable approach in modern medicine, providing effective pain relief and promoting patient comfort during various surgical or medical procedures. The combination of local anesthesia and sedation allows patients to remain conscious while ensuring a relaxed and anxiety-free experience. As medical practices continue to evolve, the careful consideration of patient factors, vigilant monitoring, and an individualized approach to anesthesia contribute to the success and safety of procedures performed under local anesthesia with sedation. This method plays a crucial role in enhancing the overall patient experience and facilitating the successful completion of a wide range of medical interventions.