THE DANGER OF TWILIGHT ANAESTHESIA AND MAJOR SURGERY

I am often asked by patients if they can have their procedure done under Twilight Anesthesia, commonly known as twilight sleep, enabling easy awakening.

Well it all depends on the definition of “twilight” anaesthesia. Traditionally the concept of Twilight anaesthesia was based on the fact that the patient was given sedating drugs but not an endotracheal tube or mask.

In the United States it is common practice to use Twilight because of the definitions and thus the costings of general anaesthesia.

As a practising surgeon I have no problem giving a patient a small amount of sedation to relax them whilst the main anaesthesia is injected into the area.

I am not however comfortable with the concept of doing a major procedure under Twilight anaesthesia.

In my view twilight is more dangerous because the airway is not protected and should the patient vomit during the procedure their airway would be compromised and a serious complication could ensue.

I’m sticking to general anaesthesia for the vast majority of my procedures, allowing me to perform surgery without interruptions, safely, maximising the optimal outcome for my patients.