Experience of Immediate Ambulation and Early Discharge After Tumescent Anesthesia and Propofol Infusion in Cosmetic Breast Augmentation.

Abstract

Current cosmetic breast augmentation relies on general anesthesia that normally requires 40min to total recovery. With experience, the surgical procedure can be completed expediently in 20min under tumescent anesthesia and propofol full sedation to achieve immediate postoperative ambulation and home discharge readiness, and thus improve patient satisfaction and reduce cost. We retrospectively examined the outcomes of the protocol. Per protocol, 1200 female patients underwent simple cosmetic breast augmentation accomplished with tumescent anesthesia, immediate mobilization, and early home discharge readiness after surgery. The following records were analyzed: vital sign stability during mobilization in the first 30 cases (primary goal), duration of surgery and anesthesia, frequency of intraoperative opioid use, frequency of ambulation needing assistance, Verbal Analog Scores and incidences of pain, orthostatic intolerance events, incidences of postoperative nausea and vomiting or anti-emetic use, and complications at follow-up visits (secondary goal). Hemodynamics during immediate postoperative mobilization demonstrated no statistically significant fluctuations and/or orthostatic intolerance requiring interventions. The mean duration of surgery was 20.4±4.1min. The mean duration of anesthesia was 25.2±6.8min. All patients tolerated immediate postoperative ambulation well. Adverse postoperative events were scarce. Only 9.1% reported postoperative pain, and 5.7% reported postoperative nausea and vomiting. One percent had transit post-ambulation dizziness needing supine positioning for less than 3min. The average time to meet home-readiness criteria was 4.7min, and there was no incidence of hematoma, infection, or complaints at follow-ups. For simple cosmetic breast augmentation, instead of general anesthesia and 40min of recovery time, a tumescent anesthetic technique can be used for immediate postoperative ambulation and a 4.7-min home discharge readiness without a decrease in anesthesia quality and safety. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .