Document Detail

Breast implant procedures under conscious sedation: a 6-year experience in 461 consecutive patients.
MedLine Citation:
PMID:  23629098     Owner:  NLM     Status:  MEDLINE    
BACKGROUND: Breast implant procedures are commonly performed using general anesthesia; however, patient apprehension, the potential for improved safety, lower costs, and faster recovery times have increased interest in the use of conscious sedation in plastic surgery. The authors examined the safety and efficacy of breast implant procedures performed under conscious sedation over a 6-year period using their standardized institutional protocol.
METHODS: Between 2002 and 2008, 461 consecutive patients underwent breast implant procedures under conscious sedation using a protocol of preoperative intravenous diazepam along with intraoperative midazolam, fentanyl, and local anesthetic. All operative and follow-up data were recorded. Augmentation mammaplasty patients were further analyzed for conscious sedation medication dosing.
RESULTS: The study population was divided into two groups (years 1 to 3 and years 4 to 6 of the study period) to analyze changes to the authors' regimen over time. In years 4 to 6, higher preoperative doses of diazepam (p = 0.01) allowed more effective local anesthesia administration, thereby reducing intraoperative fentanyl requirements (p < 0.0001). Midazolam doses and operating times did not differ significantly between groups. No patient required conversion to a deeper method of anesthesia. The overall complication rate was 4.34 percent.
CONCLUSIONS: The authors' study demonstrates the safety and efficacy of conscious sedation in breast implant procedures. Higher preoperative doses of diazepam have significantly reduced fentanyl requirements, resulting in shorter recovery times, decreased postoperative nausea/vomiting, and elimination of unintended admissions. These benefits are obtained without increasing operative times or complications. The authors conclude that conscious sedation is the preferred method of anesthesia for most patients undergoing breast implant procedures.
Michael S Gart; Jason H Ko; Kamaldeep S Heyer; Thomas A Mustoe
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Plastic and reconstructive surgery     Volume:  131     ISSN:  1529-4242     ISO Abbreviation:  Plast. Reconstr. Surg.     Publication Date:  2013 May 
Date Detail:
Created Date:  2013-04-30     Completed Date:  2013-07-16     Revised Date:  2014-10-13    
Medline Journal Info:
Nlm Unique ID:  1306050     Medline TA:  Plast Reconstr Surg     Country:  United States    
Other Details:
Languages:  eng     Pagination:  1169-78     Citation Subset:  AIM; IM    
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MeSH Terms
Aged, 80 and over
Ambulatory Surgical Procedures / methods
Anesthetics, Intravenous / administration & dosage
Anesthetics, Local / administration & dosage
Breast Implantation / methods*
Conscious Sedation / methods*
Diazepam / administration & dosage*
Dose-Response Relationship, Drug
Fentanyl / administration & dosage*
Follow-Up Studies
Midazolam / administration & dosage*
Middle Aged
Postoperative Complications / prevention & control
Retrospective Studies
Treatment Outcome
Young Adult
Reg. No./Substance:
0/Anesthetics, Intravenous; 0/Anesthetics, Local; Q3JTX2Q7TU/Diazepam; R60L0SM5BC/Midazolam; UF599785JZ/Fentanyl
Comment In:
Plast Reconstr Surg. 2013 Nov;132(5):865e-866e   [PMID:  24165642 ]
Plast Reconstr Surg. 2013 Nov;132(5):864e-865e   [PMID:  24165641 ]

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