全凭静脉麻醉复合右美托咪定在面部美容手术中用于血流动力学稳定和加速康复。

Total Intravenous Anesthesia With Dexmedetomidine for Hemodynamic Stability and Enhanced Recovery in Facial Aesthetic Surgery.

机构信息

University of Louisville, Louisville, KY, USA.

Department of Plastic Surgery, Harvard University, Cambridge, MA, USA.

出版信息

Aesthet Surg J. 2022 Oct 13;42(11):NP602-NP610. doi: 10.1093/asj/sjac113.

DOI:10.1093/asj/sjac113

PMID:35512645

Abstract

BACKGROUND

Patients undergoing facial rejuvenation surgery are at unique risk of perioperative complications from the anesthetic utilized during the procedure. The ideal anesthetic agent is one that is safe to use in the outpatient population, has analgesic, sedative, and anesthetic properties, yet does not cause respiratory depression or hemodynamic irregularities.

OBJECTIVES

A retrospective analysis of a large outpatient facelift cohort was performed to determine if dexmedetomidine, an α 2-adrenergic receptor agonist, meets the criteria of an ideal adjunct for propofol in a total intravenous anesthesia protocol.

METHODS

The charts of 791 patients who underwent rhytidectomy with total intravenous anesthesia were reviewed and data of patients' operative risk factors, perioperative management including medications administered, perioperative vital signs, and postoperative adverse events were recorded. Statistical univariate analyses were performed on the data.

RESULTS

Dexmedetomidine resulted in a significant reduction and maintenance of blood pressure from onset of anesthesia until discharge from the postanesthetic recovery unit. The utilization of opioids and anxiolytics was significantly less than previously reported for other anesthetic types. The postoperative nausea/vomiting rate was 0.8% (6 patients). There were no postoperative admissions for inpatient management. Forty-three (5.3%) patients required a conversion to general endotracheal anesthesia and statistically significant risk factors include increased BMI, American Society of Anesthesiologists Class II or higher, preoperative hypertension, and multiple procedures performed.

CONCLUSIONS

This study demonstrated the safety and efficacy of dexmedetomidine in a large cohort of outpatients undergoing facelift. Dexmedetomidine meets the requirements for an ideal adjunct anesthetic within a total intravenous anesthesia protocol.

摘要

背景

接受面部年轻化手术的患者在手术过程中由于所使用的麻醉剂而面临独特的围手术期并发症风险。理想的麻醉剂应在门诊人群中安全使用，具有镇痛、镇静和麻醉特性，但不会引起呼吸抑制或血流动力学异常。

目的

对大量门诊面部提升队列进行回顾性分析，以确定右美托咪定（一种α2-肾上腺素能受体激动剂）是否符合丙泊酚全静脉麻醉方案中理想辅助药物的标准。

方法

回顾了 791 例接受全静脉麻醉下除皱术的患者的病历，并记录了患者手术风险因素、围手术期管理（包括给予的药物）、围手术期生命体征和术后不良事件的数据。对数据进行了统计学单变量分析。

结果

右美托咪定可显著降低并维持麻醉起始至离开麻醉后恢复室期间的血压。与其他麻醉类型相比，阿片类药物和镇静剂的使用明显减少。术后恶心/呕吐发生率为 0.8%（6 例）。无术后因住院治疗而入院的病例。43 例（5.3%）患者需要转为全身气管内麻醉，统计学上显著的风险因素包括体重指数增加、美国麻醉师协会分级 II 级或更高、术前高血压和同时进行多项手术。