Jeffrey Jumaily Facial Plastic Surgery, Los Angeles, CA, United States of America.
Department of Anesthesiology, Perioperative Medicine and Pain Management, Jackson Memorial Hospital, University of Miami Miller School of Medicine, Miami, FL, United States of America.
Am J Otolaryngol. 2022 Mar-Apr;43(2):103352. doi: 10.1016/j.amjoto.2021.103352. Epub 2021 Dec 24.
Facial plastic surgical procedures are performed under either general anesthesia (GA) or sedation. GA is often associated with post-operative nausea and longer recovery, while deep sedation is thought to greatly facilitate perioperative patient comfort and expedite recovery. The objective of this study was to compare these two anesthetic techniques in a relatively healthy patient population undergoing facial plastic surgery and to discuss optimizing patient safety with a deep sedation technique.
A non-randomized, prospective cohort study was conducted to evaluate patients undergoing facial plastic surgery with a focus on rhinoplasty under either deep intravenous sedation (DIVS) in an ambulatory surgery center or under GA in a community hospital. Patients were between ages 18-65 and agreed to participate in the study and complete a quality of recovery (QoR-40) survey. Two-tailed Student's t-test was done for numerical data and Chi-squared test for categorical data.
Twenty-three patients and 16 patients had surgery under DIVS and GA, respectively. Compared to the GA group, the DIVS group had less post-operative nausea and vomiting (21.7% vs 50%, P = 0.04; 4.3% vs 37.5%; P = 0.004, respectively), shorter emergence time (4 vs 13 min, P < 0.001), and higher QoR-40 scores for almost all the categories except for physical independence. There were no post-operative medical or surgical complications.
DIVS appeared to be safe in the office-based setting and provided a higher quality recovery after a predominantly rhinoplasty-based practice compared to the GA group. Vigilant monitoring of the patient is crucial for careful titration of sedation to avoid respiratory depression and possible compromise of the surgical result from having to rescue the airway.
面部整形手术可在全身麻醉（GA）或镇静下进行。GA 通常与术后恶心和较长的恢复期相关，而深度镇静被认为极大地促进了围手术期患者的舒适度并加快了康复速度。本研究的目的是比较这两种麻醉技术在接受面部整形手术的相对健康的患者人群中的效果，并讨论使用深度镇静技术优化患者安全性。
进行了一项非随机、前瞻性队列研究，以评估在日间手术中心接受深度静脉镇静（DIVS）下或在社区医院接受 GA 下进行的鼻整形术的患者。患者年龄在 18-65 岁之间，同意参与研究并完成术后恢复质量（QoR-40）调查。对数值数据采用双尾学生 t 检验，对分类数据采用卡方检验。
23 例患者和 16 例患者分别在 DIVS 和 GA 下进行了手术。与 GA 组相比，DIVS 组术后恶心和呕吐的发生率更低（21.7%对 50%，P=0.04；4.3%对 37.5%，P=0.004），苏醒时间更短（4 对 13 分钟，P<0.001），除身体独立性外，几乎所有类别的 QoR-40 评分更高。无术后医疗或手术并发症。
在以鼻整形术为主的手术中，DIVS 在局麻环境下似乎是安全的，与 GA 组相比，术后恢复质量更高。对患者进行严密监测对于仔细调整镇静剂剂量至关重要，以避免呼吸抑制和因需要抢救气道而可能影响手术结果。
