Anesthesia Considerations of Plastic Surgery Flashcards
(226 cards)
1
Q
What are complications to anesthesia plastics?
A
DVT and PE remain the most frequent complications
N/V also common
2
Q
What are four general anesthetic considerations for plastics anesthesia?
A
patient safety is most important
DVT/PE prophlyaxis
Liposuction guidelines on lidocaine and epi doses
adequate hydration
3
Q
What are most common plastic surgery procedures performed?
A
breast augmentation (most common) liposuction, nose reshaping, eye lid surgery and facelift
4
Q
What are the most common plastic surgical procedures for females?
A
breast augumentation
liposuction
blepharoplasty
5
Q
What are the most common plastic surgical procedures for males?
A
liposuction
rhinoplasty
blepharoplasty
6
Q
What case examples can be done by conscious sedation?
A
facial surgeries: rhytidoplasty, coronal, open rhinoplasty, blepharoplasty, otoplasty, laser dermabrasion, implants, fat grafting/ synthetic materials
7
Q
What case examples can be done GA?
A
facial surgeries: rhytidoplasty, coronal, open rhinoplasty, rhioplasty with bone fracture
body surgery: breasts or pectorals, liposuction, torso, breast pexia of inferior segment, buttocks implants,
8
Q
What case examples can be done by MAC?
A
blepharoplasty, otoplasty, implants, fat grafting/ synthetic materials
9
Q
What case examples can be done by epidural?
A
breast or pectoralis liposuction torso abdominoplasty breast pexia of inferior segment buttock implants brachioplasty liposuction
10
Q
What case examples can be done by spinal?
A
liposuction, abdominoplasty, buttock implants, cruroplasty
11
Q
What case examples have moderate pain?
A
rhytidoplasty, rhinoplasty with bone fracture, laser dermabrasion, breast pectorals, torso, abdominoplasty, breast pexia of inferior segment, buttock implants, brachioplasty, cruroplasty
12
Q
Pre-anesthesia Evaluation
A
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
13
Q
If patient is over what age, should they seek clearance for internist?
A
> 50 years of age
14
Q
What labs may be necessary in plastic surgery procedures?
A
pregnancy
CBC CMP Coags HIV Hep B/C
15
Q
What medications could a plastic surgery patient possibly be on?
A
NSAIDS vitamin E weight loss medications contraceptives herbs illegal drug use prescription medications thyroid hormones antidepressants benzodiazepines vitamins and minerasl
16
Q
What is important to evaluate in patient’s medications prior to surgery?
A
Assess anticoagulation, antiplatelet and procoagulant effects of medications
Potentiate effects of anesthesia
17
Q
What % of patients are possibly taking herbs as medicaitons?
A
54
18
Q
What % of patients taking herbal medications are not told to stop prior to surgery?
A
85
19
Q
What are possible pre-operative testing/ labs that are appropriate for an ASA 1?
A
clinical history physical examination blood test complete blood chemistry coagulation tests
20
Q
What are possible pre-operative testing/ labs that are appropriate for an ASA 2/3?
A
clinical history physical examination specialist consultation EKG Chest Xray blood test complete blood chemistry UA coagulation tests
21
Q
What preoperative testing may be requested?
A
ECHO for ASA 2/3
HIV
hepititis
pregnancy (2/3)
22
Q
What is melatonin preoperatively help with?
A
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
23
Q
What monitors are needed intra-operatively for plastic surgical procedures?
A
PIV, EKG, BP, pulse oximetry, EtCO2, temperature probe
24
Q
What equipment is needed intra-operatively for plastic surgical procedures?
A
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
25
Goal for emergence
no increase in BP/HR, no bucking and no respiratory complications
26
What surgical procedure can temperature decrease quickly and why?
liposuction because irrigating with cool fluids
27
What are the benefits of regional anesthesia for plastic surgeries?
fewer complications
safer recovery
post operative analgesia
28
What are general anesthetic techniques for plastics?
inhalations
| IV combined
29
What are regional anesthetic techniques for plastics?
neuraxial, peripheral nerve blocks, local, bier blocks
30
What are conscious sedation/MAC considerations for plastics?
important to remember that patient maintains the integrity of the airway and its protective reflexes (unlike general anesthesia)
need to be prepared to secure the airway and covert to GA technique
31
What combinations of medications are heavily utilized in plastics?
anxiolyitcs, sedatives, hyponotic agents, opioids and alpha 2 agonist
32
What are level of the BIS monitor is awake?
98-100
33
What is BIS level is minimal sedation?
78-82
34
What is BIS level is moderate sedation?
70-80
35
What is BIS level is deep sedation?
60-70
36
What is BIS level is general anesthesia?
45-60 goal 45-50
37
What is BIS level is overmedicated?
<45
38
What a BIS helpful for?
useful for patients receiving propofol- ketamine anesthesia
39
How long is the recording delay with a BIS?
15-30 seconds in real time
40
What is helpful to have in conjunction with BIS?
EMG electrolmygram (EMG)
41
What does the EMG with the BIS monitor?
electrical activity of frontalis muscle between the eyebrows
| spikes suggest patient arousal
42
What are the goals of general anesthesia in the plastic surgery relam?
rapid induction, adequate operative conditions, hemodynamic stability, fast recovery, absence of side effects and good control of pain and emesis
43
What are the risks of general anesthesia in PS?
```
difficult intubation
failed intubation
kinked/occluded ETT
AGM errors
MH
```
44
What airway is more frequently used in plastics?
LMA
45
What is a risk of airway fire?
room air general/ LMAs are considered "okay"
| airway fire with open airway above the xiphoid process
46
What plastic surgical procedures have possible high fire risk?
facelifts
47
What medication is not given in the office setting?
relaxation/ NMR
48
What plastic surgical procedures are good for subarachnoid anesthesia?
liposuction, buttock implants, calf implants, breast (?)
49
What medication can be added to subarachnoid anesthesia as an adjunct for surgeries more then 2 hours?
clonidine
fentanyl
sufentanil
50
What are the advantages to subarachnoid anesthesia?
safe
early discharde
low cost
rare complications
51
What surgeries can LA be inserted by the plastic surgeon?
blepharoplasty
chin implant
liposuction
52
What is the risk of epidural or combined spinal-epidural or peripheral nerve blocks?
How long the block will last and when it will were off in relation to the surgical time
53
What are three breast procedures?
breast augmentation
breast reduction
breast lift
54
Describe blood supply to the breast
Medial aspect is the internal mammary artery
| Lateral aspect is the lateral thoracic artery
55
What is venous drainage for the breast?
superficial veins under the dermis and deep that parallel the arteries
56
Where does lymph drain in the breast?
retromammary lymph plexus in the pectoral fascia
57
Describe nerve supple to the breast
peripheral nervous system innervation of the anterior and lateral cutaneous branches of the 4th and 5th and 6th intercostal nerves
thoarcic spinal nerve, T4 innervates the nipple areola complex
58
What are two populations of individuals receiving breast augmentations?
healthy vs breast cancer
59
What anesthetic techniques can be performed for a breast augmentation?
```
General
cervicothoracic epidural
intercostal block
fascial plane block
tumescent injection with lidocaine
```
60
Is the cervicothoracic epidural better or worst analgesia than general anesthesia?
better analgesia
61
What does the cervicothoracic epidural cover?
C7-T4
62
What is an adjunct to breast augmentation?
fascial plane blocks
no sympathetic blockade
hemodynamic stability
63
What are the three possible incisions for a breast augmentation?
infra mammary
peri areolar
transaxillary
64
Where is the implant placed for a breast augmentation?
in pocket under mammary gland or pectoralis muscle
65
Where can post-operative pain extend to in an breast augmentation?
sternum, lateral thorax, middle back
66
What medications are good for postoperative pain management?
NSAIDs, low dose opioids and tramadol
67
What are anesthetic considerations for a breast augmentation?
Position changes
bra placed at end of case
pain managemnet
68
What are the position changes encountered in breast augmentation surgery?
```
head secured to table
eye protection
arms padded and wrapped to arm boards
extension on PIV
extensions on circuit
```
69
What are possible complications with breast augmentation surgery?
capsular contracture
hematoma
infection
wound dehiscence
70
What is an capsular contracture?
Capsular contracture is a local complication thought to occur due to an excessive fibrotic foreign body reaction to the implant. It is thought to be an inflammatory reaction which causes fibrosis through the production of collagen [3], leading to excessively firm and painful breasts [6].
71
What is the most common cancer globally?
breast cancer
72
What ethnicity is breast cancer more common in women under 45?
black women
73
What ethnicity has the highest risk of BRCA?
Ashkenazi Jewish women
74
What % of breast cancer is linked to genetics?
5-10%
75
What % of breast cancer has no family history? How does this occur?
85%
| genetic mutations due to aging process and life
76
What are three different breast surgeries? (smaller)
excisional biopsy
breast biopsy
lumpectomy
77
How can a breast biopsy be completed?
GA regional or with local sedation
outpatient, minimal EBL,
1-1.5 hours
78
What is the positioning for a breast biopsy?
supine
arm abducted
table turned
79
How can a lumpectomy be performed?
GA
regional
local with sedation
<1.5 hours, outpatient procedure
80
What is the positioning for a lumpectomy?
supine
81
What needs to avoided in a lumpectomy? Why?
muscle relaxants to watch axillary nodes
82
What is a lumpectomy?
Nonpalpable lesions are usually discovered on routine screening mammography or on diagnostic workup using breast
ultrasound or breast MRI. Microcalcifications, masses, densities, and architectural distortion fall into the category
of potentially malignant lesions. Breast ultrasound can identify complex cystic or solid masses, and MRI can show
areas of abnormal vascular enhancement. In these instances, the breast usually feels and looks normal. Typically, the
radiologist places one or more percutaneous hookwires in close proximity to the lesion, using local anesthesia. Later,
in the operating room, the surgeon then uses the hookwire(s) as an anatomical guide to locate and excise the area of
abnormality. These procedures are referred to as wire-localization breast biopsies or lumpectomies. In the OR,
the surgeon removes the breast tissue surrounding the wire and confirms the removal of the wire and target lesion
on specimen radiography and/or ultrasound. Bracket wire localization refers to placement of multiple hookwires
to mark the periphery of a larger lesion or multiple lesions so tissue can be removed between the bracketing wires
-- JAFFEE
83
What is a sentinel lymph node biopsy for?
small, invasive breast cancer
84
What is dissected in the sentinel lymph node biopsy?
axillary node
85
Is their relaxation in a sentinel node biopsy?
no
86
What is the sentinel lymph node?
first node to drain the afferent lymphatics from the area of the leison
87
What is injected around the breast in a sentinel node biopsy?
dye
88
When dye is inject in a sentinel node biopsy what may or may not happen to the patient?
transient drop in pulse oximetry
| allergic reaction
89
What probes are placed to identify lymph node in a sentinel node biopsy?
gamma probe
90
What are you waiting for in a sentinel node biopsy?
pathology
if positive
axillary dissection
91
What nerve damage can occur in breast surgery?
```
long thoracic nerve (motor)
thoarcodorsal nerve (motor)
intercostobrachial nerve (sensory)
intercostobrachial neurgalgia (post mastectomy pain syndrome)
lymphedema
```
92
If damage to long thoracic nerve what can be seen?
winged scapula (scapula alata) from paralysis of the serratus anterior muscle
93
What surgeries can damage to the long thoracic nerve occur?
radical mastectomies or with any removal of axillary lymph nodes
94
What results in thoarcodorsal nerve damage?
palsy of the latissimus dorsi muscle
95
What results in damage to the intercostobrachial nerve?
numbness or pain in the lateral aspect of the axilla and medial aspect of the upper arm
96
What results in intercostobrachial neurgalgia (post mastectomy pain syndrome)?
pain in axilla, medial upper arm and anterior chest wall
97
When is lymphedema most common?
axillary dissection and axillary radiation
98
What are two types of mastectomies?
modified or partial
| total or simple or radical
99
What is a radical mastectomy?
removal of breast, pectoral muscle, and axillary lymph nodes
100
What is a total/simple mastectomy?
removal of breast only
101
What are general anesthetic considerations for mastectomy? (4)
supine, IV/NIBP/Pulse ox on opposite arm
EBL 150-500
usually admitted overnight
1.5-7 hours of reconstruction
102
What are preoperative considerations for mastectomies?
respiratory/ airway compromise possible if radiation
chemotherapy (cardiomyopathy)
metastasis
anemia or chemotherapy
103
What are intra-operative considerations for mastectomies?
```
GA (ETT/LMA) or regional
avoid muscle relaxants during axillary dissection
position changes
pressure changes during emergence
high incidence of PONV
```
104
What are immediate interventions for breast reconstruction?
temporary tissue expander
| autologous myocutaneous flap
105
What is relative contraindication to breast reconstruction?
postoperative chest radiation
106
What are the five flaps for breast reconstruction?
Deep Inferior Epigastric perforator (DIEP)
superifical inferior epigastric artery (SIEA)
transverse upper gracilis (TUG)
gluteal (buttocks)
transverse rectus abdominis myocutaneous (TRAM)
107
What the most common flaps for breast reconstruction?
TRAM
| DIEPs
108
Describe the DIEP flap
deep inferior epigastric perfortator flap
abdominal skin, fat and deep inferior epigastric vessels are removed and replanted to create new breasts
internal mammary artery and vein are transected suprasternal and anastmosed to epigastric vessels
109
What is avoided with DIEP flaps?
vaspressors (microvascular case)
doppler used to check vessels
avoid hypertension/ fluid overload
110
What can be used to check tissue perfusion with a DIEP flap?
indocyanine green
111
What are complications to the DIEP flap?
```
ICU disposition
risk of graft failure
venous congestion
fat necrosis
bleeding
```
112
What blood pressure medication is preferred in DIEP flaps and why?
ephedrine because indirect MOA
| Albumin is preferred for fluid administration and expansion
113
Describe a latissimus dorsi flap
transfer of back tissues (latissimus muscle, fat, blood vessels on skin) to the mastectomy site
thoracodorsal artery supplied the flap and left attached to its original supply
114
When is the patient turned prone for the latissimus dorsi flap?
following (after) the mastectomy
115
What is required for a latissimus dorsi flap?
implants
| overnight stay in hospital
116
Describe a TRAM flap
transverse rectus abominis myocutaneous flap (pedicl or free flap type)
117
What is a TRAM flap also known as
tummy tuck breast reconstruction
118
What do you want to avoid in a TRAM flap?
hypotension
119
What is the TRAM flap based on?
superior epigastric vessels
120
What is more painful a TRAM or DIEP flap? Why?
TRAM is more painful and stimulating because the muscle is utilized
121
What are anesthetic considerations for breast reconstruction?
```
long procedure time
blood/fluid loss
multiple peripheral IVs
General anesthesia
Keep warm and hydrated
foley catheter
postoperative pain management (regional block)
```
122
What are complications to breast reconstruction that are related to chemotherapy?
pulmonary fibrosis, interstitial infiltrates, pleural effusions with methotrexate, cyclophosphamide, bleomycin
cardiomyopathy with adriamycin
myleosuppression
123
What are some medications considerations for breast reconstruction?
ephedrine > phenylephrine for hypotension (avoids vasoconstriction)
heparin intraoperative
dextran for flap procedures
124
What is avoid in breast reconstruction surgeries?
No N20
125
Why dextran for flap procedures?
reduces clot formation in microvasculature
126
What do you need to monitor for with dextran?
allergic reactions (ARDS)
127
What rate is dextran run?
25-30ml/h (low molecular weight)
128
What are necessary as pre-operative evaluation with mammoplasty reduction?
back pain
skin irritation/ infection
skeletal deformities
respiratory disorders
129
What are the techniques for reduction mamoplasty?
inferior pedicle with long curved horizontal incision across crease beneath breast
inferior pedicle with vertical incision and short horizontal at crease (less scarring and short time)
130
Can reduction mammoplasty be completed with an LMA?
yes
131
If liposuction is added to the reduction mammoplasty what complication does the anesthesia provider need to be aware of?
lung puncture
132
What are anesthetic considerations for breast reduction? (7)
```
general anesthesia
frequent position changes
longer procedure (3-5)+
fluid warmer/bair hugger/ foley catheter
fluid/ blood volume deficits
PONV
23 hour stay
```
133
What are complications to a breast reduction?
```
wound dehiscence
infeciton
seroma
hematoma
skin flap necrosis
loss of sensation
hypertrophic scarring
```
134
What are 7 abdominal surgeries?
```
liposuction
abdominoplasty
abdominal muscle repair
360 degree liposuction
body sculpting
"mommy makeover"
tummy tuck
```
135
What surgery has the highest morbidity and mortality in plastic surgery?
liposuction
136
What is the second most common plastic surgical procedure?
liposuction
137
What is liposuction?
removing fat from unwanted areas
| abdomen, hips, waist, torso, neck, extremities, pectoral region
138
What are some pre-operative considerations for patients coming for liposuction?
assess for cardiomyopathy
pulmonary disease
pulmonary embolus
throbmbophilia
139
What are the 4 methods to perform liposuction?
dry technique
wet technique
super wet technique
tumescent method
140
What is dry technique?
aspiration cannula inserted into space where fat will be removed
141
What is the EBL in dry technique liposuction?
24-40% of aspirated volume
142
What is wet technique?
200-300 ml of solution injected into each area to be treated
143
What is the EBL of wet technique liposuction?
4-30% of volume aspirated
144
What is super wet technique?
infiltrated solution= amount to be removed
| 1:1 ration
145
What is the EBL of super wet technique liposuction?
EBL is 1% of volume aspirated
146
What is the tumescent method?
large amount of solution (3-4ml per ml of expected aspirate) injected into fatty tissue
147
What is the EBL of tumescent method liposuction?
1% of aspirated volume
148
Describe tumescent solution
removal of SQ fat UNDER ANESTHESIA infiltrated wiht large volumes of saline solution with epinephrine and lidocaine
149
What is klein's s solution?
50 ml of 1% lidocaine + 1 ml 1:1000 epinephrine + 12.5ml 8.4% NaH2CO3 + 1000 NS
150
What is hunstad solution?
1000LR + 50ml of 1% lidocaine + 1ml of 1:1000 epinephrine
151
What is the lidocaine max for liposuction procedures?
35mg/kg of TBW
| being injected into lipid cells/SQ tissue therefore very slow absorption into the systemic system
152
What is the total epinephrine max for liposuction procedures?
50mcg/kg
153
What is the purpose of bicarbonate in the tumescent solution (Klein's)?
increased pH and helps reduce pain
| favors faster entry into nerve cell where lidocaine acts
154
What solution lacks a burning sensation?
Hunstad
| LR ( sodium load is also reduced)
155
What is required for liposuction procedures?
monitoring, cardiac resuscitation, ventilatory support, recovery under anesthesia care
ie adequate PACU needed
156
What are the possible complications of liposuction?
```
LAST
hypothermia
fat embolism, DVT, PR
acute anemia
pulmonary edema
fluid overload
electrolyte imbalances
death
```
157
What does of epi reduces the absorption of SQ lidocaine by 50%?
1:200,000
158
What is the max dose of lido with epi/max?
500mg
159
What is the max total volume allowed to be removed in a single session of liposuction?
<5L or 5% of body weight
160
What do higher volumes of fat removal in liposuction lead to?
hypovolemia, bleeding, electrolyte disturbances
161
Describe IVF management in Liposuction for < 4L
maintenance fluid only
162
Describe IVF management in Liposuction for >4L
maintenance + 0.25ml/ml removed after 4L
163
What is the goal of IVF management in liposuction?
maintain normal intravascular volume with postanesthestic Hct> 30% and albumin >3g
164
What are anesthetic considerations for liposuction?
```
GA SCDs
compression garnment
incision sites are closed with sterile dressings
pain related to amount of fat removed
tissue trauma from suctioning
```
165
If large volumes of liposuction are taken, monitors required are
foley
bair hugger
fluid warmer
166
What are complications for liposuction?
```
PE
fat embolus
fluid overload
LAST
epinephrine toxicity
hemorrhage
nerve damage
```
167
Describe the fluid status throughout liposuction
60% of solution infused remains in tissues (and will be absorbed)
third spacing into surgical cavity
168
What can Over/under estimation of fluid shifts can lead to
PE or hypovolumic shock
169
What is 360 degree liposuction?
liposuction of the entire tuncal midsection
170
What is the goal of 360 degree liposuction?
complete curvier contour from every angle
171
What can 360 degree liposuction be combined with?
dermolipectomy, plication of the rectus abdominis muscle, umbilicoplasty or gluteal fat grafting
172
What is an abdominoplasty?
surgery of the abdominal wall
umbilicus circumcised and blood supply preserved
resection of skin excess (pubis to costal margin)
173
What position are patients in for abdominoplasty?
semi-fowlers position
174
What is lipoabdominoplasty?
abdominoplasty + liposuction
175
Who is an abdominoplasty common?
patients who have had multiple pregnancies, or those who have lost alot of weight or after bariatric procedures
176
What can be combined with abdominoplasty?
plication (folding) of the rectus abdominis muscle
177
What are anesthetic considerations for the abdominoplasty?
2-5 hours procedure length
post gastric bypass, ensure patients have stable weight for six months prior to surgery with stable health status
overnight monitoring of comorbidities and extent of surgery
GA
fluid warmer, bair hugger, foley, PIV, antibiotics
PCA +/- epidural for postoperative pain management
178
What are possible labs for a abdominoplasty?
CBC, CM, EKG, liver function
179
Describe the emergence for an abdominoplasty?
smooth emergence, antiemetics, binder placement, semi-fowler
180
What are complications for abdominoplasty?
ileus, infection, dehiscence, fat embolus, DVT
181
What needs to happed for closure after an abdominoplasty?
flex the table to reduce tension on suture lines
182
What is a mommy makeover?
breast augmentation, breast lift, buttock augmentation, liposuction, tummy tuck, vaginal rejuvenation
183
What is the goal of a mommy makeover?
to restore shape and appearance after childbearing
184
What block is appropriate for abdominal contour surgeries?
spinal block up to T4
| need to prolong anesthetic time up to 5 hours or longer
185
What should be prevented in mommy makeovers?
DVT
PE
infections
Postoperative Pain
186
What is autologous fat grafting?
transfer of fat from one or more areas to other areas in order to improve body contour
natural filler, available and easy to obtain
unpredictable % of reabsorption
187
What are the frequent areas for autologous fat grafting?
hip buttocks
| breast face and hands
188
What are the three phases of autologous fat grafting?
harvesting adipose tissue, processing of lipoaspirate, reinjection into receptor site
189
What anesthesia is better for autologous fat grafting?
spinal anesthesia
190
What are 7 cosmetic facial surgeries?
```
rhytidoplasty
rhinoplasty
blepharoplasty
buccal fat removal
lip lifts
chin implants
eyebrow lift
```
191
What is rhytidoplasty?
face lift
192
What anesthesia can be used for rhytidoplasty
local anesthesia (subcutaneous and nerve blocks) can be combined with conscious sedation
193
What is the most common complication of rhytidoplasty?
hematoma
194
What are pre-anesthetic considerations for rhytidoplasty?
10 mg oral melatonin + 2 mg sublingual lorazepam + 0.1-0.2 mg oral clonidine 1 hour prior to surgery
+ 5-10mg mophrine/ 25-50 mcg fentanyl + PONV prophylxis
195
What is avoided in rhytidoplasty?
no paralysis for facial nerve monitoring
196
What is needed for rhytidoplasty?
smooth emergence
197
What is a brow lift?
resuspension of brows
| hair line incision with flap
198
What is a blepharoplasty?
lid lift
| manipulation of periorbital fat can result in retrobulbar hematoma and blindess
199
What reflex do you have to be conscious of in blepharoplasty
occulocardiac reflex
| decreased HR and BP
200
What anesthesia can be administered for blepharoplasty?
local anesthesia and IV sedation
201
What is possible in blepharoplasty?
laser use
202
What are anesthetic considerations for brow, face and lid lifts?
```
supine table turned away
LA with epinephrine
antibiotics
steroids
1-2 hours
outpatient
LA with sedation so patient can open and close eyes during procedure
corneal protection
```
203
What medications can be used for maintenance for a rhytidoplasty?
ketamine + midazolam
Ketamine + propofol
dexmedetomidine + opioid
204
How is oxygen delivered to maintain normal O2 saturation in rhytidoplasty?
nasal cannula
205
What anesthetic should avoided in rhytidoplasty?
GA
only for complex patients who cannot tolerate/ cooperate with conscious sedation
no need for muscle relaxation
avoid coughing and bucking on extubation due to bleeding at surgical site
206
What is a septorhinoplasty?
face lift with septum repair
outpatient
open closed or both
207
What is a rhinoplasty?
surgical manipulation of the nasal form for aesthetic and/or functional improvement
208
What do they augment with in rhinoplasties?
silion, gortex, synthetic material, cadaveric or autologous tissue (rib, cranium, iliac crest)
209
What happens at the end of a rhinoplasty?
splinting with packing at end
210
Anesthetic considerations for rhinoplasty?
MAC with infraorbital/nasocillary block
GA
table turned away from AGM
211
What are implications of MAC with infraorbital/nasocillary block or a rhinoplasty?
vasoconstrictor-soaked packs placed prior to incision
| if increased amount of blood pooling, safer to use GA
212
What are implications of GA for a rhinoplasty?
```
regular ET or Oral RAE
OG tube at end of surgery to remove blood in stomach
HOB elevated at end of case
nasal packing
smooth emergence
PONV prophylaxis
```
213
What are strategies for postoperative pain control?
multiple neural ending injuries in liposuction, tummy tuck and breast implants
start analgesia in pre-anesthetic phase with pre-emptive strategies
NSAIDs + opioids most commonly used
celecoxib, tramadol, ketorlac, acetaminophen, pregabalin, gabapentin, ketamine, esmolol on induction
214
Why are patients admitted to hospital after plastic surgery?
uncontrolled pain, nausea, vomiting or urinary retention
215
Discharge criteria for outpatient or short-stay procedures depends on
ASC/ hospital requirements
216
What are the most common errors or incidents that cause severe neurological damage or death?
cardiopulmonary events
217
What are the poor outcomes related to?
facilities, type of surgery, and/or surgeon, physical status of patient, quality of anesthetic care
218
What are plastic surgical deaths related too?
bronchospasm, deep sedation, illicit drug use, thromboembolism, fluid shifts
219
What are the 5 requirements for plastic surgery procedures?
appropriate pre-anesthetic evaluation, informed consent, appropriate monitoring, appropriate anesthesia and post anesthetic care
220
What are the most common complications to plastic surgery?
DVT and PE
221
What is appropriate prophylaxis for DVT and PE?
compression stockings
intermittent pneumatic compression tools
venous foot pumps
low molecular weight heparin
222
What increases the risk of complications?
longer anesthesia time
223
What is the most common and most unfavorable complication after plastic surgery?
PONV
224
What does PONV lead to?
increased bleeding, delayed discharge adn increased cost of care
225
What medication can be given as antiemetic effect?
10 mg of propofol
226
What are eight non-asethetic conditions treated by plastic surgery?
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congenital abnormalities
oculoplastic conditions
hand surgery
malignancy
burns
facial palsy
wound management
vascular malformations
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