Perioperative Hypertension Management during Facelift under Local Anesthesia with Intravenous Hypnotics

Chung, Ki Ho; Cho, Myeong Soo; Jin, Hyeong Min

doi:10.5999/aps.2017.44.4.276

Cited by 9 publications

(5 citation statements)

References 9 publications

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“…However, the frequent occurrence of reflex tachycardia is one of its disadvantages and is often a concern of anesthetists. 4 In the present case, tachycardia did not occur until the second infusion of propofol. This transient tachycardia was likely still a reflexive reaction to the drop in blood pressure, which was induced by a combination of the effects of both nifedipine and the anesthetics (especially propofol and sufentanil).…”

Section: Discussionsupporting

confidence: 40%

Bradyarrhythmia and hypotension during anesthetic induction—reconsideration of nifedipine: a case report

Zhang

2021

J Int Med Res

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Cardiac events sometimes occur during anesthesia and surgery and may be severe or even life-threatening. This report describes a case of severe bradyarrhythmia during anesthetic induction with propofol, midazolam, sufentanil, and vecuronium. The patient took nifedipine sustained-release tablets on the morning of surgery as routine treatment for hypertension, and this medication may have contributed to the bradyarrhythmia. Nifedipine is a calcium channel blocker that can dilate blood vessels, depress the activity of the sinoatrial node, and delay the conduction of the atrioventricular node. Although these effects are not usually significant, they may be enhanced by anesthetics or other concomitant drugs. For patients of advanced age, especially those with autonomic disturbance or cardiac abnormalities, these effects can be remarkable, and discontinuation of nifedipine should be considered.

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Section: Discussionsupporting

confidence: 40%

Bradyarrhythmia and hypotension during anesthetic induction—reconsideration of nifedipine: a case report

Zhang

2021

J Int Med Res

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“…In general, systolic blood pressure of <150 mm Hg and diastolic blood pressure of >65 mm Hg are recommended. The possible causes of perioperative hypertension are anxiety, epinephrine, pain, postoperative nausea and vomiting (10). Another major advantage of local anaesthesia techniques is the stability of blood pressure during and after the procedure.…”

Section: Discussionmentioning

confidence: 99%

The cervicofacial lift under pure local anaesthesia diminishes the incidence of post-operative haematoma

Moris

Bensa²,

Gerenton

et al. 2019

Journal of Plastic, Reconstructive & Aesthetic Surgery

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The cervicofacial lift is a frequently performed procedure in plastic surgery. It is the reference technique for facial rejuvenation and restoration of the oval form of the face and it is essential to treat excess skin. One of the most frequent complications of this procedure is the formation of haematomas. The aim of this article is to analyze the incidence of bleeding in the standard cervicofacial lift carried out under pure local anaesthesia. The entire operation, including liposuction and tightening of the SMAS, can be done under local anaesthesia. A total of 1500 patients, who have undergone cervicofacial lift under pure local anaesthesia between November 1995 and January 2016, were included in the study. The incidence of early bleeding (in the first 15 days following the operation) was recorded and analyzed. Pre-intra-and postoperative monitoring of the arterial blood pressure revealed stable pressure in the peri-operative period. The mean difference in blood pressure when comparing the intraoperative to the postoperative periods was 7 mmHg for the systolic BP [range from 3 -25] and 4 mmHg [range from 2 -12] for the diastolic BP, with lower mean values in the postoperative period. We identified nine bleeding events in 1500 patients (0.6%). The cervicofacial lift under pure local anaesthesia does not radically modify the surgical technique. It allows better control of arterial blood pressure of patients throughout the surgical procedure and avoids fluctuations in blood pressure, which is one of the main causes of bleeding and haematoma formation. The infiltration of xylocaine adrenaline combined with the absence of hypotensive general anaesthesia diminishes the incidence of haematoma and ensures an early return home for the patients.

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“…Also, even though the most critical risk factor that causes postoperative bleeding is elevated systolic blood pressure, the effect of systolic blood pressure differences on bleeding complications was not considered. In general, a systolic blood pressure of <150 mmHg is recommended [17]. Intra-and postoperative blood pressure patterns also vary depending on the method of anesthesia (local or general).…”

Section: Discussionmentioning

confidence: 99%

Epinephrine Infiltration and the Incidence of Bleeding Complications after Surgical Debridement of Pressure Ulcers with Negative Pressure Wound Therapy

Kim

Cheon

et al. 2019

J Wound Manag Res

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Background: For reducing intraoperative bleeding, epinephrine is commonly used as a vasoconstrictor with infiltration anesthesia. However, the effects of epinephrine on postoperative bleeding complications are still a matter of debate. Bleeding is a potential complication of negative-pressure wound therapy (NPWT), which is widely used in the post-debridement management of pressure ulcers. We hypothesized that the risk of post-debridement bleeding would be greater if negative pressure were applied postoperatively to pressure ulcers while bleeding conditions were masked by the vasoconstrictive effect of epinephrine. Methods: A 3-year retrospective chart review of 38 patients who received 204 surgical debridement and NPWT procedures was performed to evaluate the incidence of bleeding complications by type of local infiltration (i.e., no infiltration, lidocaine infiltration only, or infiltration of lidocaine mixed with epinephrine). Results: A total of 18 postoperative bleeding complications were observed, eight from the non-injection group and five from each of the lidocaine and lidocaine-epinephrine injection groups. Procedures with epinephrine infiltration had a 31.9% higher rate of bleeding complications than others, but the difference was without statistical significance. Conclusion: The use of epinephrine for infiltration led to a higher risk of bleeding complications when NPWT was applied after pressure sore debridement, but this trend did not reach statistical significance. A more detailed and extensive future study would help obtain more conclusive results.

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Perioperative Hypertension Management during Facelift under Local Anesthesia with Intravenous Hypnotics

Cited by 9 publications

References 9 publications

Bradyarrhythmia and hypotension during anesthetic induction—reconsideration of nifedipine: a case report

Bradyarrhythmia and hypotension during anesthetic induction—reconsideration of nifedipine: a case report

The cervicofacial lift under pure local anaesthesia diminishes the incidence of post-operative haematoma

Epinephrine Infiltration and the Incidence of Bleeding Complications after Surgical Debridement of Pressure Ulcers with Negative Pressure Wound Therapy

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