Anesthesia In Cosmetic Surgery Research Articles

Total intravenous anesthesia of propofol-remifentanil for patients of cosmetic surgery

Objective To explore the effect of propofol-remifentanil total intravenous anesthesia in cosmetic surgery and the controllability of anesthesia. Methods According to the American Society of Anesthesiologists (ASA), levelsⅠ-Ⅱ hospitalized patients for elective cosmetic surgery (100 cases) were randomly divided into two groups, namely propofol-remifentanil total intravenous anesthesia group (Group T) and combined intravenous inhalational anesthesia group (Group C), 50 cases each. Observatory items of patients included intraoperative cardiovascular drug use, body movement, waking-up time, extubation time, leaving time from operation theatre, postoperative adverse reaction, hypoxemia (SpO2<95%) and anesthesia satisfaction. Results In Group C, waking-up time, extubation time and leaving time from operation theatre were (12.2±3.6), (13.8±4.6) and (4.6±5.8) min, respectively, which were longer than those (6.7±2.6), (7.8±3.3) and (3.3±3.8) min in Group T (P 0.05). Satisfactory rate with anesthesia was 84.0% (42/50) in Group T that was higher than 52.0% (26/50) in Group C (P<0.05). Conclusions Propofol-remifentanil intravenous anesthesia has definite effects with faster postoperative recovery, less adverse reaction and complications, safety and operablity. Key words: Propofol; Remifentanil; Total intravenous anesthesia; Combined intravenous inhalational anesthesia; Cosmetic surgery

Anesthesia for Cosmetic Surgery

Increasing numbers of plastic surgery procedures are performed in diverse environments, including traditional hospital operating rooms, outpatient surgery centers, and private offices. Just as plastic surgeons develop areas of specialization to better care for their patients, anesthesiologists have specialized in outpatient plastic surgery, both cosmetic and reconstructive. The methods they utilize are similar to those for other procedures but incorporate specific techniques that aim to better relieve preoperative anxiety, induce and awaken patients more smoothly, and minimize postoperative sequelae of anesthesia such as nausea and vomiting. It is important for plastic surgeons to understand these techniques since they are the ones who are ultimately responsible for their patients' care and are frequently called on to employ anesthesiologists for their practices, surgery centers, and hospitals. The following is a review of the specific considerations that should be given to ambulatory plastic surgery patients and the techniques used to safely administer agreeable and effective anesthesia.

ANESTHESIA IN COSMETIC SURGERY

Tired of hearing of evidenced-based medicine? Want to know how “I” do it? Then, Anesthesia in Cosmetic Surgery is for you. To our medical colleagues who are just recently discovering the art and science of the ambulatory anesthesia model, this is an interesting voyage into the belly of the beast. Dr Friedberg has long been a proponent and passionate advocate of the joys and the differences of the outpatient anesthesia experience to his medical colleagues, and this book provides the forum to expound on the insights he has gathered over the years.Dr Friedberg has been an innovator of the technique and concept he has coined “minimal invasive anesthesia” or “MIA.” Dr Friedberg contends that using a drug combination of propofol, ketamine, and clonidine combined with the use of bispectral index (BIS) monitoring makes outpatient anesthesia for cosmetic surgery simple, safe, and effective. Rather than being supported by peer-reviewed publications and studies, the author generally relies upon personal anecdotes and his extensive clinical experiences.What results is a “cookbook” on “how to do what I do” that has its inherent biases and limitations, but also sets the groundwork for validation of the technique, and makes one reexamine current techniques. On the other hand, there are excellent referenced, succinct, and readable chapters on regional anesthesia of the head and neck for plastic surgical procedures, preanesthetic assessment for the ambulatory patient, herbal supplements, and a very interesting discussion of the maximum doses of lidocaine. Any practitioner involved in sedation/anesthesia for outpatients would benefit from them.The author is very experienced in many of the nuances of an anesthesiologist's role in the ambulatory setting including fiscal, regulatory, and medico-legal aspects of this type of practice. These chapters are of great value for those anesthesia caregivers contemplating an office-based setting for their practices.I found this book a very interesting read for the dentist anesthesiologist and oral and maxillofacial surgeon who have been practicing this model for 140 years, but want to see what they have been doing validated, and see their practice through the eyes of another anesthesia provider. It certainly is an eye-opener to those whose sole anesthesia venue is the operating room.

Anaesthesia in Cosmetic Surgery

B. L. Friedberg ( ed .) Cambridge University Press , ISBN 978-0-521-87090-0 , 263 pp ., Price £55 This publication from the Cambridge University Press focuses on an area of medical practice that is almost entirely consumer-driven. The phenomenon of ‘Office-based Anesthesia’ (i.e. not in the hospital setting) is widespread in the USA, and it is from this standpoint that this book is compiled. The editor, and all but one of the chapter authors, are based in the USA, and thus bring a different experience of the issue when compared to readers on this side of the Atlantic. The book comprises 18 chapters, divided into three parts; Minimally Invasive Anesthesia (MIA)®, alternative anaesthesia approaches, and other considerations. The first chapter is entitled ‘Propofol Ketamine with Bispectral Index (BIS) Monitoring’, which is written by the editor. In it, he describes his technique for the administration of anaesthesia for all cosmetic surgery patients, which is explored further in the next few chapters. The remainder of the first, and the second, part contain chapters on local and regional anaesthetic techniques, as well as more conventional forms of general anaesthesia for cosmetic surgery. The photographs and illustrations, although not in colour, complement the text well and the description of local anaesthetic blocks in head and neck surgery is excellent. The third part deals with more diverse topics. There is a very extensively referenced chapter on psychological aspects of cosmetic surgery, and a series of chapters on the economic, political and medicolegal aspects of office-based practice. Although these are written from an American perspective, it is interesting to see these topics addressed in a medical text. In the changing world of healthcare provision, an appreciation of these issues will be vital. Anesthesia in Cosmetic Surgery is written in a relatively personal style. This brings the advantage of readability, and allows the chapter authors to demonstrate the principles behind their own practice clearly and persuasively. Nowhere is this more apparent than in the chapters contributed by the editor. This personalised style allows Dr Friedberg to offer a detailed ‘recipe’ for his own trademarked technique, with information boxes offering checklists, tips for success, and pitfalls to avoid. This style of writing has drawbacks, however. The personalised, almost didactic, style has a tendency to read as a treatise to justify the author’s point of view, rather than a balanced summary of the evidence. A passage in the preface reads, ‘The reader who demands level 1 study to accept new solutions to clinical problems is reminded that neither aspirin nor penicillin ever had a level 1 study to validate their efficacy.’ Perhaps not, but if introduced today, a study of this kind would be necessary. This reviewer does not doubt the efficacy of the MIA® technique, but I found that the style of the argument detracted from the usefulness of the message. Does this book deserve a place on your bookshelf or in your departmental library? If you practice in this area, or have an interest in anaesthesia outwith the traditional hospital setting, then this book will provide much food for thought. You may even adopt the editor’s own anaesthesia technique. If, however, you are looking for a balanced overview of the subject, then you may wish to look elsewhere.

Anesthesia in Cosmetic Surgery.

Miller School of Medicine, University of Miami, Miami, Florida. cobas@miami.eduAnesthesia in Cosmetic Surgery. Edited by Barry L. Friedberg, M.D. Cambridge, United Kingdom, Cambridge University Press, 2007. Pages: 263. Price: $95.00.You know you are in for an interesting read when in the foreword the author is compared to Einstein in 1905. The implication of the foreword is that novel theories, whether about relativity or anesthesia for cosmetic surgery, may initially be considered heresy but prove to be correct over time. Anesthesia in Cosmetic Surgery does not disappoint readers: It is an engrossing book with novel ideas about one of our fastest growing fields of specialty.The book is divided into two main parts. The first is dedicated to the description of anesthesia techniques, while the second deals with peripheral, but nonetheless important, aspects of the practice of anesthesia in an office setting. It also includes two very interesting appendixes covering nutrition in the patient undergoing cosmetic surgery and another curiously covering a contributor’s own experience as an expert witness in judicial cases.The first thing that catches your attention when reading this book is the dedication and passion Dr. Friedberg has put into the development of what he calls “minimally invasive anesthesia” (MIA). This is the name he has chosen to give to a drug combination of propofol, ketamine, and clonidine supplemented with Bispectral Index monitoring, which he claims is practically infallible and has minimal side effects for patients undergoing cosmetic surgery. This MIA technique is the foundation of the book, and the tediousness of its description is counterbalanced by the enthusiasm and self-promotion that the author provides. The self-promotion includes frequent references to the author’s personal case log and experiences with MIA, both of which are used to support most of the book’s contentions about the utility of MIA.Therein rests the book’s main limitation: Most of the methods presented and supportive evidence are developed from the author’s personal perspective. The efficacy of MIA is not cemented by outcomes from large clinical trials. On the other hand, the book is written by authors well versed in the area of cosmetic surgery, making it a valuable apprentice-type text. The final result reads mostly as a how-to, easy-to-follow book rather than an extensive review.Some specific chapters are worth mentioning. The chapter on lidocaine use in cosmetic surgery is an excellent source for understanding how the concept of dosing and megadosing of this local anesthetic has become so prevalent. One is hard-pressed to find strong evidence on the currently recommended maximum dose of lidocaine of 7 mg/kg when using epinephrine in cosmetic surgery settings. The chapter, well written and unobtrusive, provides a clear insight of how this maximum dosage came to be and provides valuable tips on using this drug safely for cosmetic surgery.The chapter on regional blocks for cosmetics surgeries of the head and neck is well organized, with numerous illustrations and photographs depicting their performance. Another interesting chapter, albeit rather short, discusses preanesthetic assessment. This chapter includes a subsection on herbal supplements that are so prevalent today, especially in the cosmetic surgery population.The book also covers important aspects of cosmetic surgery such as the psychological aspects of the patient undergoing cosmetic surgery, regulations that govern ambulatory surgical centers in most states, and business, politics, and medicolegal considerations in the realm of office-based anesthesia. These chapters are compact and full of useful information, even for those who practice outside that setting.Whether Dr. Friedberg becomes the Albert Einstein of anesthesiology remains to be seen. However, his book seems to hold value for those who care for patients undergoing ambulatory processes when a premium is placed on rapid operating room turnover, attaining street readiness, and maximizing patient satisfaction.Miller School of Medicine, University of Miami, Miami, Florida. cobas@miami.edu

Book Review: Anesthesia in Cosmetic Surgery.

Book Review: Anesthesia in Cosmetic Surgery.

Anesthesia in Cosmetic Surgery

Anesthesia in Cosmetic Surgery

Anesthesia in Cosmetic Surgery

Anesthesia in Cosmetic Surgery

Anesthesia in Cosmetic Surgery by BARRY L. FRIEDBERG, EDITOR

Anesthesia in Cosmetic Surgery by BARRY L. FRIEDBERG, EDITOR

Anesthesia in Cosmetic Surgery by BARRY L. FRIEDBERG, EDITOR

Dermatologic SurgeryVolume 34, Issue 1 p. 90-90 Anesthesia in Cosmetic Surgery by BARRY L. FRIEDBERG, EDITOR BRETT COLDIRON MD, FACP, BRETT COLDIRON MD, FACP Cincinnati, OHSearch for more papers by this author BRETT COLDIRON MD, FACP, BRETT COLDIRON MD, FACP Cincinnati, OHSearch for more papers by this author First published: 05 December 2007 https://doi.org/10.1111/j.1524-4725.2007.34016.xRead the full textAboutPDF ToolsExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinked InRedditWechat No abstract is available for this article. Volume34, Issue1January 2008Pages 90-90 RelatedInformation

Anesthesia in Cosmetic Surgery

Anesthesia in Cosmetic Surgery

Book Review: Anesthesia in Cosmetic Surgery

Book Review: Anesthesia in Cosmetic Surgery

Current Trends in Local Anesthesia in Cosmetic Plastic Surgery of the Head and Neck: Results of a German National Survey and Observations on the Use of Ropivacaine

The goal of this study was to evaluate at the national level the current practice in the use of local anesthetics in cosmetic head and neck surgery and to compare the results with the novel local anesthesia technique used in the authors' department over the past 2 years. A questionnaire was posted to all 211 board-certified members of the Association of German Plastic Surgeons. The questions related to the daily practice in rhinoplasty, blepharoplasty, otoplasty, face lift, and forehead lift. The focus was laid on anesthesia techniques, local anesthetics, vasoconstricting agents, dosages, activity onset, observed side effects, mean duration of each procedure type, and surgeon satisfaction with the anesthetic used. A total of 86 questionnaires (40.8 percent) were returned. The overall analysis revealed that local anesthetics were used in 88.9 percent of all cosmetic procedures of the head and neck. Prilocaine 1% (Xylonest; AstraZeneca, Wedel, Germany) was the most frequently used local anesthetic (32.0 percent), followed by lidocaine 1% (Xylocaine; AstraZeneca) and mepivacaine 1% (Scandicaine; AstraZeneca). Ropivacaine 0.2% (Naropin; AstraZeneca) was used only by 1.1 percent and ropivacaine 0.75% only by 0.9 percent (including two of the authors). Approximately half of the respondents (47.2 percent) used epinephrine 1:100,000 for vasoconstriction. In face lifts, the necessity of repeated "top-up" infiltration was reported in more than half (54.7 percent) of the procedures. Ten percent of surgeons surpassed the maximum recommended dosages when working without ropivacaine. Overall adverse cardiovascular effects were reported in 5.9 percent of rhinoplasties and 8.1 percent of face lifts performed mostly with prilocaine and lidocaine. No adverse cardiovascular reactions or overdoses were noticed with the use of ropivacaine. The survey showed a clear trend toward the increasing use of local anesthetics in cosmetic surgery of the head and neck. Although the use of prilocaine and lidocaine prevailed, adverse cardiovascular reactions in up to 8.1 percent seem high for cosmetic procedures. Furthermore, the need of additional intraoperative top-up infiltration adds to an uncontrolled cumulative effect and patient discomfort. On the basis of their positive 2 years of experience with ropivacaine, the authors strongly believe that ropivacaine offers significant advantages, both in efficacy and prolonged duration of analgesia, while reducing the risk for adverse side effects due to lesser toxicity. This observation deserves further investigation in an established comparative study.

Local anesthesia in cosmetic surgery

Local anesthesia in cosmetic surgery

Anesthesia in Cosmetic Surgery

Despite its potential safety, the use of local anesthesia has definite risks, many of them avoidable with proper technique and monitoring. Problem areas are excessive amounts of premedication, excessive administration of epinephrine, overadministration of “caine” derivatives, and hypoxia.