Today's post highlights the risks of plastic surgery in Korea as we read of yet another patient death. Sadly a 35 yo HK lady died during liposuction at a clinic near Sinsadong yesterday.
https://www.google.co.uk/amp/m.koreatimes.co.kr/pages/article.amp.asp?newsIdx=282646
How can one die from liposuction? 1. If propofol iv is injected without access to a ventilator and the patient stops breathing like the late Michael Jackson. 2. With massive blood loss from extensive liposuction, the patient may go into cardiac arrest. 3. If combined with fat transfer, a pulmonary embolism may occur if fat is injected into a blood vessel.
The risk of surgery in an outpatient surgery clinic has been highlighted before with lack of resuscitation equipment or ventilator as one finds in a large hospital. The risk of larger hospitals is the use of shadow doctors or even dentists who may not even be board certified and may be paid a mere 500-700,000 krw per case.
With patient deaths, Korean fines realised have only been in the region of a mere 300,000 krw as death by negligence is not classified as murder in Korea nor is it recognised but instead the doctor may be charged with fraud, ie use of a shadow.
http://www.newpolice.kr/news/articleView.html?idxno=106
Prices are cheaper in outpatient surgery clinics as often times iv sedation is administered by a nurse or doctor himself. If you are lucky you may get a qualified anaesthetist but with ratios of anaesthetist to doctor often 1:3 or more in small clinics, the one anaesthetist is usually sitting in on cases requiring general anaesthesia. In Korea it is common for mask general anaesthesia with nitrous oxide and oxygen which can be unpleasant to inhale before drifting to sleep. In the UK they use iv propofol then intubate while asleep so it is less unpleasant and the ratio of anaesthetist to surgeon is 1:1, ie every case, whether twilight iv or GA, has an attendant anaesthetist present at all times. In the UK and US, prep is done while the patient is asleep. In Korea I have been strapped to the theatre table awake and prepped with cold disinfectant over my face and body. This part is unpleasant and could be avoided if they put the patient to sleep first as in the UK.
There is also a difference in postop analgaesia. In Korea they do not give opiates like cocodamol or tramadol but only tylenol/paracetamol. You may wish to bring voltarol/diclofenac with you (swallow with milk to neutralise stomach acid and do mot take if you suffer from asthma or have a bleeding problem) when you fly to korea but narcotics like codeine are not permitted into korea. This means you may face agonising postop pain when recovering from rib cartilage extraction for rib rhino, extensive liposuction or even worse for bone facial contouring when on simple tylenol.
In Korea patients report intense throat pain after general anaesthesia like a knife cutting into their throat. This could be due to mucosal injury from forced intubation with the endotracheal tube, ie intubating roughly. In the US postop pain relief is adequate to provide analgaesia to cover any mucosal injury.
In cases of surgical complications, it may be nigh impossible to fly back to address the concern so the additional cost to fix in your own country should be taken into account in patients who fly overseas for plastic surgery.
For those who have never had general anaesthesia, there is a risk just like for young people running their first marathon, that a hereditary heart condition may be present and undiagnosed like IHSS or cardiomyopathy or valvular heart disease. Often times this is not picked up on ecgs and may require an echocardiogram or stress ecg test. Neither are done in korea as preop assessments and some may even forego a chest x ray and ecg in young patients. I would not recommend GA in Korea in a small clinic if it is your first time. Check with your family and relatived for any family history of heart problems.
Hope others can chime in their thoughts. For now I shall stick to plastic surgery in the UK or Belgium where I know I have a dedicated anaesthetist even for iv sedation. I think the wake up call was when I was asked to sign a consent form for iv propofol, midazolam and ketamine and told the doctor himself would administer and that there was no anaesthetist. It cost me my 400,000 krw deposit at a clinic near Sinsadong to cancel the surgery 10 minutes before I was scheduled for breast fat transfer but at least I did not risk my life unnecessarily.