LAUSR

BACKGROUND Patients undergoing facial rejuvenation surgery have unique risk of perioperative complications that are directly affected by adverse consequences of the anesthetic utilized during the procedures. The ideal anesthetic agent is one that is safe to use in the outpatient population, has analgesic, sedative, and anesthetic properties, yet does not cause respiratory depression or hemodynamic irregularities. OBJECTIVES A retrospective analysis of a large outpatient facelift cohort was preformed to determine if dexmedetomidine, an alpha2- adrenergic receptor agonist, meets the criteria of an ideal adjunct with propofol in a TIVA protocol. METHODS The charts of 791 patients who underwent rhytidectomy with total intravenous anesthesia were reviewed and data of patients' operative risk factors, perioperative management including medications administered, perioperative vital signs and postoperative adverse events were recorded. Statistical univariate analyses were performed on the data. RESULTS Dexmedetomidine resulted in a significant reduction and maintenance of the B/P from onset of anesthesia until discharge from the post-anesthetic recovery unit (130/74 pre-op to 105/57 in mmHg). The utilization of opioids and anxiolytics was significantly less than previously reported for other anesthetic types. The PONV rate was 0.8% (6 patients). There were no postoperative admissions for in patient management. Forty-three (5.3%) of patients required a conversion to general endotracheal anesthesia and statistically significant risk factors include increased BMI, ASA of class II or higher, preoperative hypertension, and multiple procedures performed. CONCLUSIONS In this large cohort of outpatients undergoing facelift with TIVA utilizing dexmedetomidine as the primary anesthetic agent we have demonstrated the safety and efficacy of dexmedetomidine and demonstrated that it meets the requirements for an ideal adjunct anesthetic within a TIVA protocol.