Anesthesia for outpatient cosmetic surgery.
ABSTRACT American Society of Aesthetic Plastic Surgery statistics show outpatient cosmetic procedures increased from 3 to 11 million (1997-2007), an increase of 457%, and $13 billion was spent. Exponential growth, complexity of cases and patients, and media attention to high-profile untoward events are accompanied with concerns for patient safety and development of safer anesthesia practices.
Improved safety and efficacy in aesthetic facial surgery include oral sedation and local anesthesia, addition of dexmedetomidine to intravenous anesthesia, and defining the 'safest' dose of lidocaine with epinephrine. A nasopharyngeal tube can be used to deliver a concentration of oxygen commensurate with recent American Society of Anesthesiologists Task Force Practice Advisory for the prevention and management of operating room fires. Analgesia for breast surgery including instillation of bupivicaine, paravertebral block, and combination dexamethasone with nonsteroidal anti-inflammatory drugs can decrease narcotic requirement and recovery time. Risks of combined gynecologic and plastic surgical procedures are not greater than those seen with either procedure alone. A coordinated team approach for patient management is essential. Pulmonary embolism remains the greatest cause of mortality.
The methods presented improve patient safety. The number of cosmetic procedures will continue to grow exponentially and evolve additional patient safety concerns. This larger population is the foundation for prospective trials to develop evidence-based anesthesia for cosmetic surgery.
SourceAvailable from: Ryan HarrisPlastic & Reconstructive Surgery 01/2015; 135(1):239e. DOI:10.1097/PRS.0000000000000783 · 3.33 Impact Factor
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ABSTRACT: Outpatient and short stay plastic surgical procedures have increased recently up to 457% due to lower prices, international availability of plastic surgeons, best and safest anesthetic techniques. This exponential growth has been facilitated by greater information in the media, most notably to the information contained in the internet. Every day more complex patients force anesthesiologist to develop better techniques using multimodal approaches before, during and after anesthesia. Nowadays is possible to perform ambulatory plastic surgical procedures in persons with medical conditions that in the past were rejected; myocardial ischemia, hypertension, coagulation disorders, lung diseases, diabetes, etc. Improved safety and efficacy in all anesthesia procedures for plastic surgery is mandatory; surgeons, patients, relatives and media have their own concerns regarding anesthesia patient protection.Topics in spinal anaesthesia, First edited by Victor Whizar-Lugo, 09/2014: chapter 3: pages 40-66; Intech., ISBN: ISBN 978-953-51-1720-9
Plastic & Reconstructive Surgery 01/2015; 135(1):238e-9e. DOI:10.1097/PRS.0000000000000784 · 3.33 Impact Factor