A Conversation with Prof. Vesna Peković Zrnić, MD, PhD
Anesthesia involves the loss or reduction of sensations such as pain and touch, with or without loss of consciousness. In plastic and aesthetic surgery, anesthesia is often essential for performing various surgical procedures. For some patients, the thought of losing consciousness and control, and placing their lives in someone else’s hands, can cause anxiety. To overcome these concerns and build trust, it is extremely important for the anesthesiologist to have extensive knowledge and experience.
Prof. Vesna Peković Zrnić, MD, PhD
A specialist in anesthesiology and one of the country’s leading anesthesiologists, Professor Peković Zrnić explains what anesthesia actually is, the different types available, and what else patients should know.
Professor Peković Zrnić is one of the pioneers of pediatric anesthesiology in the country. She founded and served as the first Head of the Intensive Care Department at the Pediatric Surgery Clinic in Novi Sad from 1988 to 1994.
She also founded and directed the Center for Anesthesia, Intensive Care and Pain Management in Children at the Institute for Child and Youth Healthcare in Novi Sad for many years.
From 1982 to 2012, she was a member of the Department of Surgery at the Faculty of Medicine in Novi Sad, where she became a Full Professor in 2004. She has served for many years on examination boards for specialist qualifications in anesthesiology and resuscitation.
She has also contributed to several professional textbooks in her field.
Since 2012, she has worked as a specialist anesthesiologist at Clinic Olymp, a specialized hospital for plastic surgery.
Professor Peković Zrnić, could you explain what anesthesia is and what an anesthesiologist actually does?
Anesthesiology is a medical specialty dedicated to relieving suffering, pain, and psychological stress in patients while improving the effectiveness of surgical treatment and patient safety. Anesthesia involves the loss or reduction of sensations such as pain and touch, with or without loss of consciousness.
Following comprehensive assessments and careful preparation, an experienced anesthesiologist uses various medical techniques and medications to guide the patient through anesthesia as safely and comfortably as possible.
It is important to emphasize that open and completely honest communication with your anesthesiologist, both during consultations and immediately before surgery, is just as important as communication with your surgeon.
This helps patients overcome unnecessary fears, understand the anesthesia process, prepare more effectively for surgery, and support their postoperative recovery. Above all, it helps identify and minimize potential risks.
During surgery, the anesthesiologist continuously monitors the patient’s vital functions using modern medical equipment, including heart activity, blood pressure, body temperature, breathing, and other relevant physiological parameters.
If any abnormalities occur, the anesthesiologist takes appropriate measures to correct them and maintain the patient’s stability throughout the procedure.
What types of anesthesia are available, and how do you decide which one to use?
The choice of anesthesia depends on several factors.
The surgical and anesthesia team considers the patient’s medical history, current health condition, the type of surgical procedure, and their combined professional knowledge and experience to determine the most appropriate approach.
The anesthesiologist provides clear and professional information about the available anesthesia techniques. Whenever medically appropriate options exist, the patient’s personal preferences are also taken into consideration.
The following types of anesthesia are used in plastic surgery:
- Local anesthesia
- Regional anesthesia
- General anesthesia
- Special techniques such as sedation, analgesic sedation, and combinations of these methods with local or, occasionally, general anesthesia.
Could you explain the different types of anesthesia in more detail?
Local anesthesia is a technique that temporarily blocks pain sensation in a specific area of the body where a surgical procedure will be performed.
The patient remains awake or may be slightly drowsy due to additional medication, but is generally conscious and aware of the procedure.
For certain interventions, local anesthetics can be applied directly to the skin or mucous membranes as creams or sprays, known as topical anesthesia.
Alternatively, they may be injected into the area where the procedure will take place, known as infiltration anesthesia.
Regional anesthesia involves injecting a local anesthetic near specific nerves or nerve structures to temporarily block pain signals from a larger region of the body.
The resulting loss of pain sensation lasts for a limited period.
General anesthesia is typically used for more extensive surgical procedures. It involves a controlled, reversible loss of consciousness and pain perception.
The patient remains unconscious throughout the procedure and does not consciously experience surgical pain.
General anesthesia may be administered through inhalation, where the patient breathes a mixture of anesthetic gases, oxygen, and air, or intravenously, where anesthetic medications are delivered directly into a vein.
A combination of intravenous and inhaled anesthetics may also be used, together with medications that promote unconsciousness, relieve pain, and relax muscles.
These combinations allow the anesthesiologist to tailor anesthesia to the procedure and the patient’s individual needs.
Sedation is a medication-induced reduction in the activity of the central nervous system, producing a state of relaxation and reduced awareness.
During lighter levels of sedation, patients generally retain their protective reflexes, can breathe independently, and may respond to verbal communication.
There is also a state known as deep sedation, in which the patient appears to be asleep and is not easily awakened. Although it resembles general anesthesia in some respects, it is not the same.
Deep sedation can affect breathing and protective reflexes, which is why careful monitoring is essential.
When sedative medications are combined with pain-relieving drugs, or analgesics, the technique is referred to as analgesic sedation.
Why is a preoperative anesthesia assessment important, and why does the anesthesiologist need detailed information about the patient’s health?
During the preoperative anesthesia consultation, patients receive information about the anesthesia techniques and procedures planned for their surgery.
This assessment also provides an opportunity for psychological preparation, helping patients understand what to expect and address any concerns.
Patients are informed about the medical examinations and laboratory tests that may be necessary before undergoing anesthesia.
It is extremely important to provide honest and accurate information about previous medical conditions, chronic illnesses, lifestyle habits such as smoking and alcohol consumption, medications, allergies, and any previous experiences with anesthesia.
All this information helps the medical team optimize the patient’s health before surgery and reduce potential risks.
If a patient has a chronic medical condition, it should be adequately controlled and treated.
The anesthesiologist determines which medications should be continued, adjusted, or temporarily discontinued before surgery.
The anesthesiologist may also recommend consultations with other medical specialists when necessary.
Acute illnesses, such as a significant respiratory infection or influenza, may require postponing an elective surgical procedure.
For patients with chronic conditions, the anesthesiologist works with the appropriate specialists and the plastic surgeon to assess the individual risks associated with the planned operation.
In addition to psychological preparation, routine preoperative preparation generally includes basic laboratory tests and an assessment of the patient’s overall medical condition, supported by a written report from the relevant physician.
Which medical tests are required before surgery?
We usually discuss this with patients during their initial consultations.
It is important that the test results are recent and accurately reflect the patient’s current health condition.
For plastic and aesthetic surgery, the following tests and assessments are commonly requested:
- Complete blood count with differential, urea, creatinine, and blood glucose
- Blood coagulation tests, such as PT, aPTT, and INR, when indicated
- Electrocardiogram (ECG)
- Internal medicine or cardiology assessment to evaluate potential medical and cardiovascular risks
Although this may sound complicated, the process is generally straightforward.
Many of these examinations can be arranged through our partner laboratories, often within a short period.
The exact tests required and their timing depend on the patient’s medical history, the planned procedure, and the anesthesiologist’s assessment.
Why is it important not to eat or drink before surgery?
Patients may be required to avoid food and certain drinks for a specified period before anesthesia.
For procedures requiring fasting, the anesthesiologist provides individual instructions about when to stop eating and drinking.
In many cases, clear liquids may be permitted until two hours before anesthesia, while a longer fasting period is required for solid food. The exact timing depends on the type of food or drink, the procedure, and the patient’s medical condition.
Anesthesia can reduce consciousness and suppress natural protective reflexes, including swallowing and coughing.
As a result, stomach contents may flow back into the throat and potentially enter the lungs, a complication known as pulmonary aspiration.
This can cause breathing difficulties, inflammation, or lung injury and may significantly affect postoperative recovery.
Before entering the operating room, patients are generally asked to remove removable dental appliances, dentures, contact lenses, and nail polish when instructed by the medical team.
After surgery and anesthesia, patients remain under medical supervision for a period determined by the procedure, type of anesthesia, and individual recovery.
In our clinic, observation may last approximately six hours, although the duration varies depending on the patient’s condition.
Once the medical team determines that discharge is appropriate, the patient receives postoperative instructions and should leave accompanied by a responsible adult.
For at least 24 hours after general anesthesia or sedation, patients are generally advised not to drive, operate dangerous machinery, drink alcohol, or make important legal or financial decisions.
Following these precautions helps reduce anesthesia-related risks and supports a safer recovery.
Could you tell us more about postoperative pain management?
During recovery from anesthesia and in the immediate postoperative period, medications and anesthesia techniques help reduce pain and discomfort.
Acute postoperative pain is often most noticeable during the first two to three days after surgery, although its duration and intensity vary.
The level of discomfort depends primarily on the type and extent of the surgical procedure, as well as the patient’s individual sensitivity to pain.
The anesthesiologist develops an appropriate pain management plan using analgesic medications and other suitable techniques.
Patients also receive instructions about how and when to take their prescribed medications.
The goal is to provide effective pain relief, minimize discomfort, and support a comfortable recovery.
Following these instructions helps us achieve the highest possible level of patient safety, which is our shared priority. A well-prepared, informed, and motivated patient is better equipped for surgery and recovery, with potential risks reduced as much as possible.
