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Total Intravenous Anesthesia (TIVA) Use of Dexmedetomidine in Facial Rejuvenation Surgery: A Ten Year Review of 791 Cases
Alec Moore, BA
T. Gerald O'Daniel, MD, FACS
University of Louisville School of Medicine
2022-01-15
Presenter: Alec Moore
Affidavit:
Alec Moore is responsible for the entirety of the data acquisition, as well as the majority of the analysis and drafting of the abstract proposal.
Director Name: T. Gerald O'Daniel
Author Category: Medical Student
Presentation Category: Clinical
Abstract Category: Aesthetics
Purpose:
An ideal anesthetic agent is one that provides amnesia, analgesia, and is an anxiolytic, without causing respiratory depression. Dexmedetomidine, an α-agonist, is an agent that may provide such benefits, able to control perioperative variables more effectively by limiting spikes in blood pressure, better preserving respiratory drive, and minimizing need for post-operative narcotics. We sought to describe the effectiveness and safety in the use of dexmedetomidine in patients undergoing outpatient facial rejuvenation surgery.
Methods:
All patients underwent an extended high SMAS facelift performed by the senior author (TGOD), with 227 of 791 cases (28.7%) having undergone 1-3 additional procedures, with the use of dexmedetomidine as the primary anesthetic agent.
Results:
With the use of a continuous infusion of dexmedetomidine, both mean intra-operative SBP (100 mmHg) and post-operative SBP (105 mmHg) were noted to be significantly less than mean pre-operative SBP (134 mmHg), p<0.0001. Similarly, both mean intra-operative DBP (55 mmHg) and post-operative DBP (57 mmHg) were significantly less than mean pre-operative DBP (74 mmHg), p<0.0001. Post-operatively, 6 (0.8%) patients experienced PONV, with 27 (3.4%) having received any Zofran and 16 (2.0%) patients requiring fentanyl. Ten (1.3%) patients developed a hematoma post-operatively.
Conclusion:
In our series, dexmedetomidine was shown to provide cardiovascular stability, synergistic effects with narcotics, and diminished need for propofol and amnestics. We experienced a reduction in frequency of PONV, post-operative narcotic requirements, and hematoma formation. Use of dexmedetomidine as part of a TIVA protocol can provide a safe and effective method of anesthesia in outpatient facial aesthetic surgery.
