Dexmedetomidine in aesthetic facial surgery: improving anesthetic safety and efficacy.

Abstract:

BACKGROUND:Dexmedetomidine is an alpha2-agonist anesthetic with several properties that are advantageous in aesthetic facial surgery. By attenuating sympathetic nervous system activity, it induces sedation and analgesia while lowering blood pressure and preventing pain-induced hemodynamic fluctuations. It spares the respiratory drive and decreases the need for supplemental oxygen, thus reducing the fire risk of electrocautery. It decreases narcotic use, thereby further improving respiratory safety and decreasing postoperative nausea and vomiting. This retrospective study evaluated the safety and efficacy of dexmedetomidine in rhytidectomy. METHODS:Records were reviewed for 155 consecutive face lifts performed under sedation by one surgeon over 3.5 years. Intraoperative and postoperative parameters and outcomes were compared for 78 patients sedated with dexmedetomidine (dexmedetomidine group) and 77 sedated without dexmedetomidine (no-dexmedetomidine group). RESULTS:Intraoperatively, the dexmedetomidine group had lower mean systolic and diastolic blood pressures and heart rate (p < 0.001). Fewer dexmedetomidine group patients had oxygen desaturation below 92 percent (p < 0.05) and fewer required antihypertensives (p < 0.01), although more required vasopressors (p < 0.01). The dexmedetomidine patients needed less midazolam (p < 0.01) and fentanyl (p < 0.001). Postoperatively, the dexmedetomidine group again had lower mean systolic and diastolic blood pressures and heart rate (p < 0.001). In addition, fewer patients in this group needed postoperative antiemetics (p < 0.05). Immediate postoperative hematomas occurred in two patients in the dexmedetomidine group and one patient in the no-dexmedetomidine group. CONCLUSIONS:Dexmedetomidine lowered blood pressure, decreased the frequency of oxygen desaturations, and reduced narcotic, anxiolytic, and antiemetic use. When compared with conventional sedation, dexmedetomidine appears to improve anesthetic safety and efficacy for rhytidectomy patients.

journal_name

Plast Reconstr Surg

authors

Taghinia AH,Shapiro FE,Slavin SA

doi

10.1097/01.prs.0000293867.05857.90

subject

Has Abstract

pub_date

2008-01-01 00:00:00

pages

269-276

issue

1

eissn

0032-1052

issn

1529-4242

pii

00006534-200801000-00033

journal_volume

121

pub_type

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