Overview
Facelift patients can have complications from the anesthetic itself. The authors asked whether dexmedetomidine works as an added drug to propofol in total intravenous anesthesia. They reviewed the charts of 791 outpatient facelift patients, recording risk factors, drugs given, vital signs and adverse events.
Findings
- 791 patients had facelift (rhytidectomy) with total intravenous anesthesia; retrospective chart review with univariate statistics.
- Dexmedetomidine produced a significant reduction in blood pressure, maintained from start of anesthesia to discharge from recovery.
- Opioid and anti-anxiety drug use was significantly less than previously reported for other anesthetic types.
- Postoperative nausea/vomiting: 0.8% (6 patients).
- No postoperative admissions for inpatient care.
- 43 patients (5.3%) required conversion to general anesthesia with a breathing tube.
- Significant risk factors for conversion: higher BMI, ASA class II or higher, high blood pressure before surgery, multiple procedures.
What it means for a patient
- Facelift can be done as an outpatient under intravenous anesthesia without a breathing tube in most cases.
- Dexmedetomidine kept blood pressure lower from the start of anesthesia until discharge from recovery. Ask your anesthesia team how they control blood pressure.
- 5.3% of patients in this series needed a switch to general anesthesia. Higher weight, high blood pressure, other health conditions and combined procedures raised that chance.
- This is a retrospective chart review with no direct comparison group; the opioid comparison is to earlier published reports.
Why this paper matters
It reports anesthesia outcomes in a large outpatient facelift group using dexmedetomidine with propofol. The authors conclude it meets their criteria for an ideal added anesthetic in this setting.
Terms
- Total intravenous anesthesia (TIVA): anesthesia given entirely through a vein, without inhaled gas.
- Dexmedetomidine: a sedative drug that calms and reduces pain without slowing breathing much.
- Propofol: a common intravenous anesthetic drug.
- Hemodynamic stability: steady blood pressure and heart rate.
- General endotracheal anesthesia: full anesthesia with a breathing tube in the windpipe.
- ASA class: the American Society of Anesthesiologists score of a patient's overall health before surgery.
- Rhytidectomy: the medical name for a facelift.