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Dr. Linder's Blog


Category: Surgical Team

Plastic Surgeon and Surgery Facility

Beverly Hills plastic surgeon

As a Beverly Hills plastic surgeon and also a member of the American Society of Plastic Surgeons (ASPS), I must perform surgery in a facility that abides by the rigorous standards set for patient safety.

As I have stated in the past few blog articles, there are many key questions to ask when determining the right surgeon for your procedure. Along with doing your due diligence to decide on the right procedure, plastic surgeon, and anesthesia, I would encourage patients to ask not only where the surgery will be held but also what type of accreditations the facility meets.

As an ASPS member, I must meet the criteria of performing surgery in accredited, state-licensed, or Medicare-certified surgical facilities only. I am proud to state that I use Brighton Surgical Center, which is located in the same building as my office in Beverly Hills and carries two of the most stringent and distinguished certifications of accreditation for ambulatory facilities and hospitals within the state of California. The center has both Medicare certification as well as accreditation from the Joint Commission of Accreditation of Hospitals (JCOH).

For your safety, please ensure that your plastic surgeon is choosing an accredited ambulatory or hospital facility for your surgery. Please give us a call at 310-275-45413 or email us if you need more information about our surgery center.


Post Anesthesia Complications / Status Post Cosmetic Surgery

Beverly Hills Plastic Surgeon Dr. Linder

Dr. Linder has been filming today for Entertainment Tonight on February 3, 2014. The topic of discussion is Post Anesthesia Hallucinations and Psychosis. In general, after speaking to our Board Certified Anesthesiologist regarding the topic of Post Anesthesia Psychosis, this is not something that we believe truly exists. We should differentiate emergence delirium versus ICU psychosis. Emergence delirium may occur as seen in pediatrics when a child awakes with agitation.

In our practice we do see younger patients who have post anesthetics under general and may have emergence delirium due to Post traumatic Stress Disorder as well. These patients can be treated quickly verbally as well as protection of them from harming themselves and using small doses of Versed or short-acting Benzodiazepine, a valium-like drug. The situation will normally resolve in just a few minutes and the patient may re-emerge after being given the valium or Versed without agitation. ICU psychosis is multi-factorial and may be associated with disorientation associated with environment of pain, lights on for 24 hours, activity such as vital signs that are taken and the patient becomes completely disoriented and progresses to a state of psychosis. This can also be treated with medications and will resolve. The anesthetic ketamine is a dissociative anesthetic which can be associated with a psychotic event. We do not use this in our practice. It is notable that patients having surgery over 4-1/2 hours under general anesthesia do increase the risk of anesthetic-related complications. The most common anesthetic-related complications include cardiac, respiratory and neurological. Our patients are monitored both pre- and postoperatively and intraoperatively with the anesthesiologist. Preoperative evaluations must include full history, physical, and psychological evaluations prior to undergoing any surgical procedure, including plastic surgery.

Plastic Surgical Team Beverly Hills

For any successful surgical outcome, it requires teamwork from several multi-talented physicians, nurses, and techs.  As you would expect, your plastic surgeon must be Board Certified with the American Board of Plastic Surgery and Diplomate of the American Board of Plastic Surgery and should also be members of the American Society of Plastic Surgeons.  The anesthesiologist putting the patient to sleep should equally be Board Certified with the American Board of Anesthesia.  Here, they should be qualified in all forms of IV sedation and general anesthetics, including the use of laryngeal mask airways and endotracheal tube intubations as well as understanding all aspects of critical care medicine.  ACLS is required from both the Anesthesiologist and the Director of Nursing.  The Director of Nursing must be a Registered Nurse in all Medicare licensed ambulatory facilities such as ours at Brighton Surgical Center.  The Director of Nursing should have years of experience in both ICU Hospital as well as ambulatory outpatient surgery facility patient management.  The Recovery Room Nurse must be a Registered Nurse as well in all Medicare State Licensed facilities.  The circulating nurse in the operating room can be an RN or an LVN.  We use RNs.  They should be well-versed at all aspects of circulating, including helping to prepare each patient in the operating room, pulling supplies, filling out all paperwork and accountability for instrument needle sponge counts with the scrub tech as well as performing a timeout at the beginning of the surgery which includes patient’s name, allergies, surgery that will be performed and antibiotics that are given.

Finally, the Certified Scrub Tech should have years of experience in plastic surgical procedure understanding the instrumentations and how to expose tissue during the operation to allow for easier surgical manipulation by the plastic surgeon.  The Certified Scrub Tech is also responsible for the sterility of all instruments and autoclaving of all supplies.  Every aspect of the chain is essential in the loop of creating excellence for our final surgical outcome.