Optimization of Conscious Sedation in Plastic Surgery

ABSTRACT

Conscious sedation is an anesthetic technique that has come into common use in a variety of medical specialties. Under the appropriate conditions and with well-trained personnel and backup, conscious sedation can be used to perform plastic surgical procedures in a safe, efficient, and flexible manner.

In this chapter, the authors address the technical aspects and fundamentals for preparation that can be used to perform plastic surgery cases under conscious sedation with success. A number of protocol variations have been described in the literature using different combinations of agents. Whether using the technique or combination of agents advocated by the authors or others, the safe administration of conscious sedation begins with careful preparation, strict patient selection guidelines, and complete familiarity with the agents. Outcome parameters for conscious sedation administration are discussed, along with techniques designed to optimize outcome from the initial steps of patient selection, through premedication and intraoperative dosing, and into recovery. The skillful use of dilute local infiltration is emphasized as one of the keys to minimizing intraoperative sedative needs, which ultimately should improve safety and decrease the incidence of prolonged recovery and adverse events such as nausea and emesis.

Most important, the surgeon must be prepared to recognize and appropriately address problems, should they arise. Conscious sedation is truly a team effort. A well-trained and properly prepared team can enable the plastic surgeon to take advantage of the many benefits that this form of anesthesia has to offer.

Keywords

Conscious sedation - midazalam - plastic surgery - nausea - emesis - ondansetron - tumescent