Anesthesia for outpatient cosmetic surgery.
OBJECTIVE
American Society of Aesthetic Plastic Surgery statistics show outpatient cosmetic procedures increased from 3 to 11 million (1997-2007), an increase of 457%, and $13 billion was spent. Exponential growth, complexity of cases and patients, and media attention to high-profile untoward events are accompanied with concerns for patient safety and development of safer anesthesia practices.


RESULTS
Improved safety and efficacy in aesthetic facial surgery include oral sedation and local anesthesia, addition of dexmedetomidine to intravenous anesthesia, and defining the 'safest' dose of lidocaine with epinephrine. A nasopharyngeal tube can be used to deliver a concentration of oxygen commensurate with recent American Society of Anesthesiologists Task Force Practice Advisory for the prevention and management of operating room fires. Analgesia for breast surgery including instillation of bupivicaine, paravertebral block, and combination dexamethasone with nonsteroidal anti-inflammatory drugs can decrease narcotic requirement and recovery time. Risks of combined gynecologic and plastic surgical procedures are not greater than those seen with either procedure alone. A coordinated team approach for patient management is essential. Pulmonary embolism remains the greatest cause of mortality.


CONCLUSIONS
The methods presented improve patient safety. The number of cosmetic procedures will continue to grow exponentially and evolve additional patient safety concerns. This larger population is the foundation for prospective trials to develop evidence-based anesthesia for cosmetic surgery.
Shapiro
Fred E
FE
Harvard Medical School, Department of Anesthesiology, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts 02215, USA. fshapiro@bidmc.harvard.edu
D000465:Algorithms; D000556:Ambulatory Surgical Procedures / Q000592:standards*; D018712:Analgesics, Non-Narcotic / Q000008:administration & dosage; D000701:Analgesics, Opioid / Q000008:administration & dosage; D000758:Anesthesia / Q000379:methods / Q000592:standards*; D000779:Anesthetics, Local / Q000008:administration & dosage; D020927:Dexmedetomidine / Q000008:administration & dosage; D005283:Fentanyl / Q000008:administration & dosage; D005390:Fires / Q000517:prevention & control*; D006801:Humans; D008012:Lidocaine / Q000008:administration & dosage; D010100:Oxygen / Q000008:administration & dosage; D017751:Safety Management; D012955:Societies, Medical / Q000592:standards; D013518:Surgery, Plastic / Q000592:standards*
D018712:Analgesics, Non-Narcotic; D000701:Analgesics, Opioid; D000779:Anesthetics, Local; D020927:Dexmedetomidine; D008012:Lidocaine; D010100:Oxygen; D005283:Fentanyl