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Optimization of conscious sedation in plastic surgery.

Publication ,  Journal Article
Marcus, JR; Tyrone, JW; Few, JW; Fine, NA; Mustoe, TA
Published in: Plast Reconstr Surg
October 1999

The administration of conscious sedation by the plastic surgeon must be safe, efficient, and consistent. In the proper setting, with trained staff and appropriate backup, conscious sedation can allow optimal patient satisfaction with expedient recovery in addition to cost containment. The highly effective local anesthesia afforded by dilute, high-volume ("tumescent") infiltration extends the use of conscious sedation to cases previously performed under general anesthesia or deep sedation. The purpose of this analysis was to identify variables in conscious sedation that affect traditional outcome parameters in ambulatory surgery, particularly the duration of recovery and adverse events such as nausea and emesis. All perioperative and operative records of 300 consecutive patients having plastic surgical procedures under conscious sedation were carefully reviewed. Patients were ASA class I or II by requisite. Conscious sedation followed a standardized administration protocol, using incremental doses of two agents: midazolam (0.25 to 1 mg) and fentanyl (12.5 to 50 mcg). A subset of patients received preoperative oral sedation. Multivariate statistical analysis was conducted using SPSS 8.0 for Windows (SPSS Inc., Chicago, Ill.). Of the 300 patients, same-day discharge was intended for 281. Eight procedure categories were defined. No anesthetic complications occurred. As expected, recovery time was significantly correlated with the duration and type of procedure (p < 0.001) and the total dosage of both intraoperative sedative agents (p < 0.001). Interestingly, a negative correlation with advancing age existed (p < 0.001), likely reflecting the significantly higher intraoperative sedative dosing in younger patients (p < 0.001). When controlled for the effects of procedure duration and intraoperative sedative dosing, two other variables-use of preoperative oral sedation and postoperative nausea/emesis-significantly lengthened recovery time (p = 0.0001 for each). Fifteen unintended admissions occurred secondary to nausea, prolonged drowsiness, or pain control needs. Conscious sedation is an effective anesthetic choice for routine plastic surgical procedures, many of which would commonly be performed under general anesthesia. In our experience with a carefully structured and controlled conscious sedation protocol, the technique has proven to be safe and effective. This analysis of outcome parameters identified two important and potentially avoidable causes of recovery delay following conscious sedation-oral premedication and nausea/emesis. Nausea and emesis were particularly problematic in that they were responsible for 11 of 15 (73 percent) unintended admissions. Preoperative sedation is valuable in certain circumstances, and its use is not discouraged; however, its benefits must be weighed against its unwanted effects, which can include a prolongation of recovery.

Duke Scholars

Published In

Plast Reconstr Surg

DOI

ISSN

0032-1052

Publication Date

October 1999

Volume

104

Issue

5

Start / End Page

1338 / 1345

Location

United States

Related Subject Headings

  • Surgery, Plastic
  • Surgery
  • Rhytidoplasty
  • Postoperative Nausea and Vomiting
  • Postoperative Complications
  • Middle Aged
  • Midazolam
  • Mammaplasty
  • Lipectomy
  • Hypnotics and Sedatives
 

Citation

APA
Chicago
ICMJE
MLA
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Marcus, J. R., Tyrone, J. W., Few, J. W., Fine, N. A., & Mustoe, T. A. (1999). Optimization of conscious sedation in plastic surgery. Plast Reconstr Surg, 104(5), 1338–1345. https://doi.org/10.1097/00006534-199910000-00015
Marcus, J. R., J. W. Tyrone, J. W. Few, N. A. Fine, and T. A. Mustoe. “Optimization of conscious sedation in plastic surgery.Plast Reconstr Surg 104, no. 5 (October 1999): 1338–45. https://doi.org/10.1097/00006534-199910000-00015.
Marcus JR, Tyrone JW, Few JW, Fine NA, Mustoe TA. Optimization of conscious sedation in plastic surgery. Plast Reconstr Surg. 1999 Oct;104(5):1338–45.
Marcus, J. R., et al. “Optimization of conscious sedation in plastic surgery.Plast Reconstr Surg, vol. 104, no. 5, Oct. 1999, pp. 1338–45. Pubmed, doi:10.1097/00006534-199910000-00015.
Marcus JR, Tyrone JW, Few JW, Fine NA, Mustoe TA. Optimization of conscious sedation in plastic surgery. Plast Reconstr Surg. 1999 Oct;104(5):1338–1345.

Published In

Plast Reconstr Surg

DOI

ISSN

0032-1052

Publication Date

October 1999

Volume

104

Issue

5

Start / End Page

1338 / 1345

Location

United States

Related Subject Headings

  • Surgery, Plastic
  • Surgery
  • Rhytidoplasty
  • Postoperative Nausea and Vomiting
  • Postoperative Complications
  • Middle Aged
  • Midazolam
  • Mammaplasty
  • Lipectomy
  • Hypnotics and Sedatives