Patients who have serious cosmetic surgery such as breast augmentation and facelifts in unregulated private offices could be at risk of serious complications and even death, doctors have warned.
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They have called on medical regulators to crack down in the growing practice of clinicians using so-called "conscious sedation", in which a patient is given large doses of anaesthetic but is supposed to remain awake.
The Australian Society of Plastic Surgeons has made a submission to the Medical Board of Australia calling for upper limits on the amount of anaesthetic that can be given to patients in private rooms and offices.
Society president Hugh Bartholomeusz said conscious or "twilight" sedation was perfectly safe if it was given with appropriate supervision and staffing. But currently, doctors using it in their own private offices were able to do so completely unregulated, unlike those operating in hospitals or day surgery centres.
"We have always been concerned about conscious sedation and the fact it allows quite large and invasive procedures like facelifts and breast augmentation and liposuction to be done in places that aren't licensed," he said.
"Conscious sedation can become unconscious sedation very quickly."
He said he was particularly concerned by the "dangerous" practice of doctors performing both surgery and anaesthetic.
"These places might look really flash … but if there is any problem, it means it all comes down to the surgeon," he said. "Most people, when they go to a surgeon, they just trust them to do what they think is right."
He said the majority of plastic and reconstructive surgeons in Australia would do invasive procedures only in a licensed facility with an anaesthetist present.
In Australia, surgeons who have done eight years of specialist plastic surgery training on top of medical school are known as plastic surgeons. However, other medical practitioners sometimes also perform cosmetic surgery and may have varying levels of training.
Phillipa Hore, chairwoman of the safety and quality committee of the Australian and New Zealand College of Anaesthetists, said there was an increasing demand for conscious sedation from cosmetic and dental patients.
"There's demand by the population for pain-free, stress-free procedures, whether they're dental or cosmetic, which is not unreasonable – everyone wants a procedure done with the least stress and pain," she said.
"But people administering local anaesthetic for cosmetic procedures may not be trained in either the delivery of appropriate doses of local anaesthetic or sedation, and this is the problem."
She said conscious sedation was often done in an effort to minimise the amount of sedation given, but if too much was given, it could have life-threatening consequences.
Patients should ask their doctors about the type of sedation given, and who would be performing it, she said.
The college has also written to the medical board calling for all clinics performing sedation to abide by its guidelines on the practice, which are endorsed by a number of other expert doctors' groups.
They state that patients should be given written information about the risks of the procedure, and have a thorough medical assessment that includes examination of their airway. Three clinical specialists should be present, include someone with expertise in airway management and CPR.
"The problem for the consumer is it's an unregulated industry and they have no knowledge of the potential problems that can occur during what they perceive to be a straight-forward procedure," she said.
