Ramos-Zabala Agustín, Pérez-Mencía M T, Fernández-García R, Cascales-Núñez M R
Department of Anesthesiology, Corporación Dermoestética, Madrid, Spain.
Lasers Surg Med. 2004;34(3):269-72. doi: 10.1002/lsm.20007.
Multiple anesthetic approaches exist for full-face laser resurfacing. The purpose of this study was to describe an anesthesia technique based on combination of eutectic mixture local anesthetics (EMLA) and remifentanil sedation, that can be utilized by anesthesiologists in the ambulatory environment.
STUDY DESIGN/MATERIALS AND METHODS: Fifty patients elected for facial laser resurfacing. All patients received topical anesthesia in full face with EMLA cream at 60 minutes (min) before laser procedure. On arrival at the operating room, intravenous (IV) sedation was administered with remifentanil (0.20 mcg/kg/minute), midazolam (1.5- 2 mg bolus IV), and propofol infusion (0.5-1 mg/kg/hour). The subsequent infusion rate of remifentanil was varied to maintain an adequate level of sedation and analgesia. Five minutes before the operation conclusion, the sedation infusion was discontinued. Patients were discharged after achieving a minimum criteria for recovery.
Almost all the patients were successfully anesthetized by this combination technique, only four patients needed complementary anesthesia with regional nerve blockade. The mean level of sedation scored 2-3 on the Ramsay scale. The mean discharge time was 55 minutes. No complications were observed.
The use of a combination of topical EMLA anesthesia and IV conscious sedation based on remifentanil provided an adequate depth of anesthesia for outpatient facial laser resurfacing without complications.
