Dexmedetomidine: a new alpha-agonist anesthetic agent for facial rejuvenation surgery.
BACKGROUND
The ideal anesthetic adjunctive agent is one that has sedative, analgesic, and anxiolytic properties and produces a predictable hemodynamic response without respiratory depression.


OBJECTIVE
We sought to determine the efficacy of dexmedetomidine as a multifunctional sedative agent for patients undergoing facial rejuvenation surgery.


METHODS
A retrospective study was conducted of 50 randomly selected, nonintubated patients undergoing extended superficial musculoaponeurotic system (SMAS) face lifts by the same surgeon. Forty-seven of the 50 patients were women; the mean age was 56.1 years. All patients received dexmedetomidine as the primary sedative agent. A total of 73 ancillary procedures were performed. Intraoperative and postoperative respiratory rate, hemodynamic stability, postoperative emergent rates, and adverse events were evaluated.


RESULTS
A continuous, titrated infusion of dexmedetomidine (0.2-0.7 mug/kg/h) controlled blood pressure with a systolic blood pressure of 120 mm Hg or less over the course of the 3- to 6.7-hour procedure in all but 8 patients, who required an intraoperative antihypertensive agent. The mean (SD) dose of midazolam and fentanyl was 4.4 (1.3) mg and 201 (64) mug, respectively, and a propofol drip was titrated for additional sedation. All patients maintained a normal respiratory rate, without obstruction or desaturation, and were taken from the operating room directly to a stage 2 recovery area. No patient required antiemetics for postoperative nausea or emesis. There was one complication consisting of a hematoma that occurred 72 hours postoperatively.


CONCLUSIONS
In our population of nonintubated patients undergoing facial rejuvenation surgery, dexmedetomidine fulfilled the properties sought in a sedative agent.
O'Daniel
T Gerald
TG
Shanahan
Patrick T
PT