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Basics of Anesthesia > Week 8 - Anesthesia for Elective Plastic Surgery > Flashcards

Week 8 - Anesthesia for Elective Plastic Surgery Flashcards

1
Q

What are the advantages and disadvantages of an open approach Rhinoplasty?

A

Advantages:

  • allows full exposure
  • precise diagnosis and correction of deformities
  • direct control of bleeding

Disadvantages:

  • external incision
  • prolonged operative time
  • delayed wound healing
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2
Q

What are the advantages and disadvantages of a closed approach Rhinoplasty?

A

Advantages:

  • limits dissection to areas needing modification (shorter operative time/rapid recovery)
  • no external scar

Disadvantages:

  • experience
  • no direct visualization
  • greater reliance on accurate preop diagnosis
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3
Q

What are anesthetic considerations for a Rhinoplasty?

A
  • GETA (some utilize local anesthesia with IV sedation)
  • Surgical Time = 1-2.5 hrs
  • EBL = 50-100mL
  • Nose often packed after surgery (unable to place nasal cannula)
  • Blood in stomach – antiemetic prophylaxis, consider OG tube
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4
Q

What is a Blepharoplasty? What are the indications?

A

Improves appearance of upper/lower eyelids

Indications:

  • loose or sagging skin (may impair vision)
  • bags under eyes
  • excess fatty deposits or puffiness
  • droopiness of the lower lids
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5
Q

What are the anesthetic considerations of a Blepharoplasty?

A
  • General Anesthetic without intubation
  • Surgical Time = 30-90 min
  • EBL = negligible
  • Monitor for oculocardiac reflex
  • Surgeon may want patient to wake up to open their eyes to assess
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6
Q

What are the indications and limitations of a traditional face lift (Rhytidectomy)?

A

Useful for generalized skin laxity

Limitations:
-not a treatment for minor wrinkles, sun damage, most creases or irregular pigmentation

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7
Q

What is endoscopic face life? What are the benefits?

A

Fiberoptic lens placed through several small incisions in mouth and temple (Less Invasive)

  • useful for limited corrections
  • generally midface and cheek areas

Benefits:
-No visible incisions, minimal scarring, less bleeding, no hair loss, minimal numbness, much quicker recovery

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8
Q

What are the anesthetic considerations of a face lift?

A
  • GETA - reinforced ETT (some utilization of IV sedation and local anesthesia)
  • Surgical Time = 4-6 hours
  • EBL = 100-250 mL
  • Blood pressure maintained at 100 systolic (to avoid excessive bleeding)
  • Planned hypertension at end of procedure (assess for bleeding)
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9
Q

What age are silicone breast implants approved for by the FDA?

A

22 years or older

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10
Q

What are the benefits of silicone breast implants?

A

More natural appearance

Softer than saline

Less rippling

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11
Q

What age are saline breast implants approved for by the FDA?

A

18 years of older

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12
Q

What are benefits of saline breast implants?

A

Very low spontaneous deflation rate

Fixed volume vs adjustable volume

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13
Q

What are the different incisional sites for breast implant procedures?

A

Inframammary

Periareolar

Axillary

Transumbilical (higher complication rate)

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14
Q

What does the method for inserting and positioning implants depend on?

A
  • Type of implant
  • Degree of enlargement desired
  • Body type of patient
  • Surgeon’s recommendations
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15
Q

What are the benefits and disadvantages of placing breast implants over the muscle?

A

Benefits:

  • Many women prefer rounded, less natural look
  • Ease of surgery
  • Reduced post op pain
  • Allows for insertion of oversized implants

Disadvantages:

  • Interference with mammograms
  • Visible rippling of skin
  • Higher rates of capsule contracture
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16
Q

What are benefits and disadvantages of placing breast implants under the muscle?

A

Benefits:

  • Natural breast shape
  • No rippling
  • Very low mammography interference
  • Good internal support
  • Minimal scarring

Disadvantages:

  • Technically difficult surgery
  • Post op discomfort
17
Q

What are anesthetic implications for breast implant surgery?

A
  • GETA
  • Surgical Time = 1-2 hours
  • EBL = negligible

-Patient often is sat up during surgery (make sure pt positioning is proper and secure)

18
Q

What are anesthetic implications of breast reduction surgery?

A
  • GETA
  • Surgical Time = 3-5 hours
  • EBL = 100-250 mL

-Postop pain management

19
Q

What are the indications of an Abdominoplasty?

A

Indicated for patients with laxity of skin in the lower trunk

Generally related to massive weight loss

Goals: flat abdominal contour, eliminate abdominal wall laxity and enhance waist definition

20
Q

What are complications of Abdominoplasty?

A
  • Wound healing
  • Infection
  • Hematoma/Bleeding
  • Tissue necrosis
  • Abdominal binder limits mobility (DVT/PE)
  • Large scar and contour asymmetry
21
Q

What are the anesthetic implications for an Abdominoplasty?

A

GETA

Surgical Time = 2-4 hours

EBL = 100mL not including blood contained in the specimen removed

22
Q

What are the characteristics of Dry Liposuction?

A

Requires general anesthesia

Limited by blood loss

Aspirate contains 25-40% blood

*generally healthy patients with limited comorbidities

23
Q

What are the characteristics of Wet Liposuction?

A

Injection of 200-300 mL fluid

Blood loss reduced to 4-30% of aspirate

24
Q

What are the characteristics of Superwet Liposuction?

A

1 mL of fluid infiltrated for each mL of fat removed

Infiltrate contains epinephrine +/- lidocaine

Blood loss is reduced to 1% of aspirate

25
Q

What are the characteristics of Tumescence Liposuction?

A
  • Infiltration of 3-4mL of fluid for each mL of aspirate
  • Contains local anesthetic 0.05 - 0.1% lidocaine mixed with epinephrine
  • No other anesthetic necessary (done without general anesthetic)
  • Evolved into an office based procedure (50% performed by non-surgeons)

*Max dose = 50 mg/kg
accepted infiltrate concentration is 35-50mg/kg

26
Q

What are the characteristics of Ultrasound Assisted Liposuction?

A

Ultrasound heats and liquefies fat

  • reduces surgeon effort
  • can cause thermal injury
  • cannot be used with dry technique
27
Q

What is considered Large Volume Liposuction?

A

Greater than 5L

  • fluid resuscitation is necessary
  • should be done in acute care setting (NOT the office)
  • 23 hour monitoring

Often split into serial procedures to reduce risk

28
Q

What are complications of liposuction?

A
  • Lidocaine toxicity (beware of tissue vascularity, peak time = 12 hours)
  • Fluid imbalances (large amount of infiltrate (50-70% left behind)
  • Pulmonary Embolism (#1 cause of death)
  • Fat embolus (small fat droplets become loosened and embolized to the lungs)
  • Hypothermia (infiltrate is at room temp or refrigerated)
29
Q

What is the fluid replacement recommendations for liposuction?

A

Small Volume (<5L)

  • maintenance fluid = replaces deficit
  • infiltrate

Large Volume (>5L)

  • maintenance fluid = replaces deficit
  • infiltrate
  • 0.25 mL of crystalloid for each mL of aspirate over 5 liters
30
Q

What is the only absolute contraindication for liposuction?

A

Hepatic disease

*many relative contraindications

31
Q

What are anesthetic considerations for liposuction?

A

General anesthesia vs MAC

Minimal postop pain

Tight binders – impede mobility, compromise respiratory function

32
Q

What are the types of flap reconstruction?

A
  • Pedicled + Tram Flap: Traverse Rectus Myocutaneous Flap
  • Free Flap
  • DIEP Flap: Deep inferior epigastric artery perforator flap
  • SIEA Flap: Superficial epigastric artery flap
  • Difference is related to blood vessels that supply the flaps
  • There are also reconstructions with thigh and buttocks flaps

*Long cases, waves of stimulation, go light on fluid to prevent issues with anastomosis

Basics of Anesthesia (35 decks)

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