Overview
The ideal added anesthetic drug sedates, relieves pain and anxiety, and keeps blood pressure predictable without slowing breathing. The authors asked whether dexmedetomidine meets these goals in facial surgery. They reviewed 50 randomly selected patients who had extended SMAS facelifts by one surgeon without a breathing tube, all with dexmedetomidine as the main sedative.
Findings
- 50 patients; 47 women; mean age 56.1 years; extended SMAS facelift by one surgeon; 73 added procedures.
- Continuous infusion of dexmedetomidine at 0.2 to 0.7 mcg/kg/h.
- Systolic blood pressure stayed at 120 mm Hg or less over the 3 to 6.7 hour procedure in all but 8 patients, who needed a blood pressure drug during surgery.
- Mean (SD) midazolam dose: 4.4 (1.3) mg; mean (SD) fentanyl dose: 201 (64) mcg; propofol drip added for more sedation.
- All patients kept a normal breathing rate, without airway obstruction or low oxygen.
- All went from the operating room directly to a stage 2 recovery area.
- No patient needed anti-nausea medication after surgery.
- 1 complication: a hematoma 72 hours after surgery.
What it means for a patient
- A facelift can be done under sedation without a breathing tube.
- In this group, dexmedetomidine helped keep blood pressure controlled during surgery, and no patient needed treatment for nausea.
- 8 of 50 patients still needed another drug to lower blood pressure during surgery.
- This is a small retrospective series from one surgeon, with no comparison group.
Why this paper matters
It is an early report of dexmedetomidine sedation in facelift surgery, with blood pressure, breathing and nausea results in 50 patients. The authors conclude it fulfilled the properties they sought in a sedative.
Terms
- Dexmedetomidine: an alpha-agonist sedative that calms and eases pain with little effect on breathing.
- Alpha-agonist: a drug that acts on alpha receptors, which can lower blood pressure and cause sedation.
- Nonintubated: without a breathing tube in the windpipe.
- Extended SMAS facelift: a facelift that lifts the deeper SMAS layer further toward the center of the face.
- Systolic blood pressure: the top number in a blood pressure reading.
- Hemodynamic stability: steady blood pressure and heart rate.
- Hematoma: a collection of blood under the skin.