Intravenous Anesthesia With Bispectral Index Monitoring vs Inhalational Anesthesia for Rhytidoplasty

Abstract

IMPORTANCE Minor adverse effects related to anesthesia are common and worrisome to patients, including perioperative vomiting, gagging on the endotracheal tube, incisional pain, and nausea. A previously published intravenous anesthesia protocol reports extremely low rates of postoperative nausea and vomiting (<1%) and decreases in postoperative pain perception compared with rates reported following administration of inhalational anesthetics.OBJECTIVE To evaluate and compare postoperative outcomes in patients after administration of combined propofol and ketamine hydrochloride anesthesia with bispectral index monitoring (PKA-BIS protocol) vs inhalational anesthesia (IA) during lower rhytidoplasty. DESIGN, SETTING, AND PARTICIPANTSWe performed a prospective, double-blind, randomized comparison trial of the PKA-BIS protocol and IA in 30 consecutive female patients undergoing rhytidoplasty by a single surgeon at a single outpatient surgery center from October 2013 to June 2014. MAIN OUTCOMES AND MEASURESOutcome measures included nausea, vomiting, pain, overall feeling of well-being, time to awaken, time to discharge, and cost. Patient measures were recorded using a combination of a 40-item validated postoperative quality of recovery questionnaire (QOR-40) and visual analog scales (VASs). Results were recorded immediately after surgery and on postoperative days 1 and 7.RESULTS A statistically significant reduction in emergence time (mean [SD], 29.8 [10.6] vs 46.0 [10.2] minutes; P < .001) and time to meet discharge criteria (51.4 [19.3] vs 66.1 [12.9] minutes; P = .02) was seen in patients in the PKA-BIS group. Patient-reported (subjective) postoperative nausea (3 of 15 [20%] vs 7 of 15 patients [47%]; P = .12; χ 2 = 2.40), vomiting (0 vs 2 of 15 patients [13%]; P = .14; χ 2 = 2.14), and confusion on the day of surgery (3 of 15 [20%] vs 6 of 14 patients [43%]; P = .18; χ 2 = 1.77) were also decreased in the PKA-BIS group, but these differences did not reach significance. Differences in global recovery scores (QOR-40 scores in the postanesthesia care unit, 158.13 [22.68] vs 155.33 [18.09]; P = .71; at day 1, 166.47 [26.39] vs 166.00 [16.00]; P = .96), postoperative overall feeling of well-being (VAS scores at day 1, 6.10 vs 6.26; at day 7, 7.49 vs 8.00), and postoperative pain perception (VAS scores at day 1, 3.40 vs 3.65; at day 7, 2.26 vs 1.81) between the PKA-BIS and IA groups, respectively, did not reach significance. The costs of anesthesia administration were similar between the PKA-BIS

Intravenous versus inhalational maintenance of anesthesia for quality of recovery in adult patients undergoing non-cardiac surgery: A systematic review with meta-analysis and trial sequential analysis

“…We obtained 19 fulltext reports to assess eligibility (Fig 1) and excluded 10 references (3 conference paper, 1 duplicate data, 1 inadequate study design, 1 different intervention, 1 outcome using QoR-15 questionnaire, 1 lack of enough information, 2 ongoing studies). Finally, 9 randomized controlled trials (RCTs) consisting of 922 patients (462 in the TIVA groups and 460 in the inhalational maintenance groups) were reviewed [3,[9][10][11][12][13][18][19][20], and data from all of these were included in meta-analysis.…”

“…Three studies compared TIVA versus maintenance using desflurane [3,13,20]. One study did not report details of the inhalational agent [19]. Remifentanil was used in both groups during anesthesia maintenance except one study using ketamine in TIVA group [19].…”

“…One study did not report details of the inhalational agent [19]. Remifentanil was used in both groups during anesthesia maintenance except one study using ketamine in TIVA group [19]. Seven studies described monitoring of depth of anesthesia in both groups using of bispectral index (BIS).…”

The Unique Practice Needs of Academic Facial Plastic and Reconstructive Surgeons

“…To the Editor Anesthesia-and surgery-related independent predictors of postoperative nausea and vomiting (PONV) have been well highlighted by Jones and LaFerriere. 1 Nevertheless, some major patient-related independent predictors seem to have been overlooked in their study. Factors contributing to the PONV include, but are not limited to, female sex, not smoking, history of PONV, motion sickness, or migraine, younger age, and duration of anesthesia.…”

“…In general plastic surgery, the trend has been toward increased nonsurgical procedures, less cosmetic surgery, and more reconstructive surgery (80%-98%) at academic institutions. [1][2][3][4]…”