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

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.

Anesthetic management for the placement of a fully implantable artificial replacement heart: a case report.

Of the patients with end-stage cardiomyopathy on a heart transplant list, 95% do not receive a donor heart. Due to this severe shortage of donor organs, an artificial replacement heart has been pursued for several decades. To date, 10 patients have received an Abiocor artificial replacement heart (Abiomed, Inc, Danvers, Mass), the latest artificial heart device available. Anesthetic management often is complicated by the preoperative multisystem organ failure arising from the patient's advanced cardiomyopathy. Hemodynamic stabilization before cardiopulmonary bypass is extremely challenging, and the postbypass period creates a unique situation in which the only control the anesthesia provider has on the hemodynamics is management of the systemic vascular resistance. This article describes the anesthetic management of the recipient of the Abiocor artificial heart with the longest survival time.