Office-based outpatient plastic surgery utilizing total intravenous anesthesia

Area of Science:

• Anesthesiology
• Plastic Surgery
• Ambulatory Surgery

Background:

• Office-based plastic surgery is increasingly popular.
• Anesthetic techniques range from conscious sedation to general anesthesia.
• Total intravenous anesthesia (TIVA) provides moderate to deep sedation without intubation, suiting office settings.

Purpose of the Study:

• To review plastic surgery procedures performed under TIVA in an outpatient office-based operating room.
• To assess patient outcomes and complications associated with TIVA in this setting.

Main Methods:

• Retrospective chart review of 2611 procedures (2003-2011) by 2 senior surgeons.
• TIVA administered by a board-certified anesthesiologist; conscious sedation by the plastic surgeon.
• Analysis of patient outcomes and complications to evaluate TIVA safety.

Main Results:

• No deaths, cardiac events, or hospital transfers occurred in 2006 patients.
• 642 patients received TIVA (propofol and/or ketamine with midazolam/fentanyl); 1364 received conscious sedation.
• One case (0.05%) of DVT/PE in a patient on oral contraceptives undergoing implant exchange under TIVA.

Conclusions:

• Office-based surgery is an attractive option for patients.
• TIVA can be used safely for various procedures in office operating rooms.
• TIVA minimizes risks associated with general anesthesia and leads to few postoperative complications when patient selection is prioritized.