Anesthesia Considerations of Plastic Surgery Flashcards
What are complications to anesthesia plastics?
DVT and PE remain the most frequent complications
N/V also common
What are four general anesthetic considerations for plastics anesthesia?
patient safety is most important
DVT/PE prophlyaxis
Liposuction guidelines on lidocaine and epi doses
adequate hydration
What are most common plastic surgery procedures performed?
breast augmentation (most common) liposuction, nose reshaping, eye lid surgery and facelift
What are the most common plastic surgical procedures for females?
breast augumentation
liposuction
blepharoplasty
What are the most common plastic surgical procedures for males?
liposuction
rhinoplasty
blepharoplasty
What case examples can be done by conscious sedation?
facial surgeries: rhytidoplasty, coronal, open rhinoplasty, blepharoplasty, otoplasty, laser dermabrasion, implants, fat grafting/ synthetic materials
What case examples can be done GA?
facial surgeries: rhytidoplasty, coronal, open rhinoplasty, rhioplasty with bone fracture
body surgery: breasts or pectorals, liposuction, torso, breast pexia of inferior segment, buttocks implants,
What case examples can be done by MAC?
blepharoplasty, otoplasty, implants, fat grafting/ synthetic materials
What case examples can be done by epidural?
breast or pectoralis liposuction torso abdominoplasty breast pexia of inferior segment buttock implants brachioplasty liposuction
What case examples can be done by spinal?
liposuction, abdominoplasty, buttock implants, cruroplasty
What case examples have moderate pain?
rhytidoplasty, rhinoplasty with bone fracture, laser dermabrasion, breast pectorals, torso, abdominoplasty, breast pexia of inferior segment, buttock implants, brachioplasty, cruroplasty
Pre-anesthesia Evaluation
most patients are healthy
low tolerance of errors or side effects
explain anesthetic technique- risk/ benefits
gain patient trust
reduce anxiety
complete history and physical examination are fundamental
NPO: 8 hours solid food and 2 hour liquids
Most (45%) of patients are 35-50 years of age
Most ASA 1/2
oveweight patients surgery may seek skin removal surgery following bariatric surgery
If patient is over what age, should they seek clearance for internist?
> 50 years of age
What labs may be necessary in plastic surgery procedures?
pregnancy
CBC CMP Coags HIV Hep B/C
What medications could a plastic surgery patient possibly be on?
NSAIDS vitamin E weight loss medications contraceptives herbs illegal drug use prescription medications thyroid hormones antidepressants benzodiazepines vitamins and minerasl
What is important to evaluate in patient’s medications prior to surgery?
Assess anticoagulation, antiplatelet and procoagulant effects of medications
Potentiate effects of anesthesia
What % of patients are possibly taking herbs as medicaitons?
54
What % of patients taking herbal medications are not told to stop prior to surgery?
85
What are possible pre-operative testing/ labs that are appropriate for an ASA 1?
clinical history physical examination blood test complete blood chemistry coagulation tests
What are possible pre-operative testing/ labs that are appropriate for an ASA 2/3?
clinical history physical examination specialist consultation EKG Chest Xray blood test complete blood chemistry UA coagulation tests
What preoperative testing may be requested?
ECHO for ASA 2/3
HIV
hepititis
pregnancy (2/3)
What is melatonin preoperatively help with?
reducing anxiety, decrease post-operative pain intensity and opioid consumption
improves postoperative sleep quality and reduces post-operative/ emergence and delirium
May also reduce oxidative stress and anesthetic requirements
What monitors are needed intra-operatively for plastic surgical procedures?
PIV, EKG, BP, pulse oximetry, EtCO2, temperature probe
What equipment is needed intra-operatively for plastic surgical procedures?
compression boots foley catheter if longer than 4 hour surgery proper positioning access to airway eyes taped (opthalamologic lubricant) sterile tape often used on eyelids