Quality of recovery and safety of deep intravenous sedation compared to general anesthesia in facial plastic surgery: A prospective cohort study

Jumaily, Jeffrey S.; Jumaily, Mejd; Donnelly, T.; Asaria, Jamil

doi:10.1016/j.amjoto.2021.103352

Cited by 9 publications

(4 citation statements)

References 12 publications

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“…Reducing postoperative pain and PONV are important factors for improving the quality of recovery after surgery [ 12 , 13 ]. Satisfactory postoperative analgesia may contribute to improving the postoperative emotional state [ 14 ].…”

Section: Discussionmentioning

confidence: 99%

Effects of Systemic Lidocaine Versus Dexmedetomidine on the Recovery Quality and Analgesia After Thyroid Cancer Surgery: A Randomized Controlled Trial

Shu

et al. 2022

Pain Ther

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Introduction Surgical management is commonly used for thyroid cancer. We evaluated the effects of systemic lidocaine versus dexmedetomidine on the recovery quality and analgesia after thyroid cancer surgery. Methods A total of 120 patients with thyroid cancer were randomly allocated to group L (received lidocaine 1.5 mg/kg loading, continuously infused 1.5 mg/kg per hour), group D (received dexmedetomidine 0.5 µg/kg loading, continuously infused 0.5 µg/kg per hour) and group C (received normal saline), with 40 cases in each group. Anaesthesia induction and maintenance were performed using target-controlled infusions (TCIs) of propofol and remifentanil. The primary outcome of the quality of recovery-15 (QoR-15) score was recorded on the day before surgery and postoperative day 1 (POD1). Secondary outcomes included the consumption of remifentanil during surgery, time to first required rescue analgesia, number of patients requiring rescue analgesia, postoperative cumulative consumption of tramadol, visual analogue scale (VAS) pain score, incidence of postoperative nausea or vomiting (PONV) and side effects. Results The total score of the QoR-15 at POD1 (median, IQR) was higher in group L (128.0, 122.0–132.8) and group D (127.5, 122.5–132.5) compared to group C (118.5, 113.0–123.5) ( P = 0.000). Compared to group C, systemic lidocaine and dexmedetomidine reduced cumulative consumption of remifentanil and VAS pain score ( P = 0.000). The time to first required rescue analgesia (mean, SD) was longer in group L (8.1 h, 1.2 h) and group D (8.5 h, 1.9 h) than group C (5.9 h, 0.9 h) ( P = 0.000). The number of patients requiring rescue analgesia was lower in group L (8/40, 20%) and group D (6/40, 15%) than group C (16/40, 40%) ( P = 0.029), and cumulative consumption of tramadol (mean, SD) was lower in group L (44.0 mg, 17.1 mg) and group D (51.7 mg, 14.1 mg) than group C (73.9 mg, 18.4 mg) ( P = 0.000). The incidence of PONV in group L (7/40, 17.5%) and group D (9/40, 22.5%) was lower than group C (18/40, 45.0%) ( P = 0.016). Bradycardia (heart rate less than 50 beats/min or lower) was noted in 25 patients (25/40, 62.5%), which was reversed by intravenous administration of atropine 0.5 mg. Conclusion Systemic lidocaine and dexmedetomidine had similar effects on enhancing the quality of recovery, alleviating the intensity of pain and reducing the incidence of PONV after thyroid cancer surgery. However, dexmedetomidine may result in bradycardia. Therefore, lidocaine was superior to dexmedetomidine. Trial registration ChiCTR.org.cn (ChiCTR2000038442). Registered on September 22, 2020.

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Section: Discussionmentioning

confidence: 99%

Effects of Systemic Lidocaine Versus Dexmedetomidine on the Recovery Quality and Analgesia After Thyroid Cancer Surgery: A Randomized Controlled Trial

Shu

et al. 2022

Pain Ther

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“…TIVA has been used to perform more invasive in-office procedures, including rhinoplasty and rhytidectomy. A nonrandomized, prospective cohort study in patients undergoing rhinoplasty in an office setting demonstrated shorter emergence time, decreased postoperative nausea and vomiting, strong safety profile, and improved quality of recovery when compared with patients undergoing GA. 26 More recently, dexmedetomidine, an α-2 adrenergic receptor blocker, has been used as an adjunct to propofol in patients who require TIVA for in-office rhytidectomy. 27 Dexmedetomidine as an adjunct to propofol has been shown to provide excellent blood pressure control, reduce the usage of opioids/anxiolytics, and provide an excellent safety profile.…”

Section: Deep Sedationmentioning

confidence: 99%

“…TIVA has been used to perform more invasive in‐office procedures, including rhinoplasty and rhytidectomy. A nonrandomized, prospective cohort study in patients undergoing rhinoplasty in an office setting demonstrated shorter emergence time, decreased postoperative nausea and vomiting, strong safety profile, and improved quality of recovery when compared with patients undergoing GA. 26 …”

Section: Intravenous (Iv) Anesthesiamentioning

confidence: 99%

Anesthesia for office‐based facial plastic surgery procedures

Bharadwaj,

Dougherty

2023

World j. otorhinolaryngol.-head neck surg.

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ObjectiveThe objective of this study is to provide a state‐of‐the‐art review on the use of anesthetics for in‐office facial plastic procedures.MethodsA search was performed on PubMed, Embase, Web of Science, and Cochrane Review using the keywords “anesthesia,” “office‐based procedures,” “local anesthesia,” “facial plastics,” “oral sedation,” “moderate sedation,” and “deep sedation.”Results and ConclusionsOver the past few decades, the shift toward in‐office invasive procedures has increased patient convenience and decreased hospital resource utilization. Many tools exist to reduce patient anxiety and discomfort in an office‐based setting. With proper patient selection and technique, facial plastic surgeons can adequately anesthetize patients to perform Mohs reconstruction, cutaneous excisions, blepharoplasty, face‐lifts, and other in‐office procedures.

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“…DIVS is often regarded as a safer alternative to GA, having shown a stronger safety profile, greater perioperative patient comfort, and improved recovery compared to traditional forms of anesthesia. 6,7 Notably, DIVS negates the need for intubation as spontaneous ventilation is maintained, reducing the risks of upper airway trauma and patient-related factors complicating anesthesia, while providing the capability of being utilized in an office-based setting under the supervision of an anesthesiologist. 8 DIVS has also been used to perform more invasive office-based procedures, reducing the use of a hospital OR and associated resources.…”

Section: Introductionmentioning

confidence: 99%

Outcomes following inguinal and subinguinal urologic procedures under deep intravenous sedation

Fidel,

Shah,

Bal

et al. 2024

CUAJ

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Introduction: We aimed to investigate the surgical outcomes following inguinal and subinguinal urological procedures under deep intravenous sedation (DIVS) with multimodal local anesthesia (LA). Methods: We conducted a retrospective cohort study from September 2022 to December 2023 including adult patients deemed eligible for day surgery (American Society of Anesthesiologist score 1–3) undergoing radical orchiectomy (RO), microscopic varicocelectomy (MV), or microscopic denervation of spermatic cords (MDSC). All procedures were performed at a single urologic ambulatory surgical center and outpatient clinic, and by a single surgeon (PP). Procedures were performed through a subinguinal or inguinal approach with DIVS and adjunctive multimodal LA. We evaluated intraoperative complications and relevant surgical outcomes and parameters. Results: A total of 103 patients were included in the analysis with a mean age ± standard deviation of 37.3±9.6. This included 25 patients who underwent RO, 54 patients who underwent MV, and 24 patients who underwent MDSC. All procedures were completed successfully without intraoperative complications. Oncologic outcomes were preserved, fertility outcomes improved, and pain scores reduced similar to the expected rates in the literature. Conclusions: Our preliminary results demonstrate the safety, effectiveness, and feasibility of performing inguinal and subinguinal urologic procedures under DIVS with LA. These findings suggest that this technique preserves high-quality care while avoiding unnecessary risks of general or spinal anesthesia, representing an opportunity to transfer these cases outside of hospitals’ operating rooms into outpatient ambulatory centers.

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Quality of recovery and safety of deep intravenous sedation compared to general anesthesia in facial plastic surgery: A prospective cohort study

Cited by 9 publications

References 12 publications

Effects of Systemic Lidocaine Versus Dexmedetomidine on the Recovery Quality and Analgesia After Thyroid Cancer Surgery: A Randomized Controlled Trial

Effects of Systemic Lidocaine Versus Dexmedetomidine on the Recovery Quality and Analgesia After Thyroid Cancer Surgery: A Randomized Controlled Trial

Anesthesia for office‐based facial plastic surgery procedures

Outcomes following inguinal and subinguinal urologic procedures under deep intravenous sedation

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