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Refined anesthesia technique for facelifts helps reduce pain, control blood pressure

Researchers have found a combination approach to anesthesia management to reduce patient anxiety and pain, as well as control blood pressure and postoperative emesis, ultimately resulted in a reduced risk of hematoma, according to the results of a recently published retrospective study.

Charts were reviewed for 1,089 face-lifts conducted at one institution between 1990 and 2013. The researchers recorded patients' demographics, operative data and anesthesia regimens, in addition to reoperation rates and the occurrence of any complications. To determine whether demographic or intraoperative variables were significantly associated with the occurrence of complications, univariate logistic regression was used. The researchers also generated a multivariate logistic regression model to evaluate whether the number of intraoperative hypertensive episodes (defined as systolic blood pressure of > 140 mm Hg) were correlated with the occurrence of postoperative complications.

Overall, 48 patients underwent extended superficial musculoaponeurotic (SMAS) procedures, 197 underwent SMASectomy or SMAS-stacking based on facial analysis, 355 underwent SMASectomy with superficial diffuse fat augmentation and 489 underwent SMASectomy with deep and superficial specific fat compartment grafting. One hundred sixty-five patients were treated for hypertension before surgery. One hundred seventy patients were recorded as having blood pressure of higher than 140 mm Hg on the day of surgery, and 354 patients in the postanesthesia care unit were reported to have hypertension.

According to the researchers, the anesthesia protocol described in the study had been performed at their facility for approximately 20 years. Patients were given benzodiazepines preoperatively to help reduce anxiety, whereas a specific combination of inhalation agents, neuromuscular blockers, antiemetics, antihypertensives and narcotics was given intraoperatively. Patients were treated as needed postoperatively for any nausea, vomiting, anxiety, pain or hypertension.

Overall, few complications were reported postoperatively, with 10 patients reported to have developed postoperative hematomas. Male sex was found to be the only demographic variable with a significant correlation to the development of postoperative hematoma, according to the researchers. Although intraoperative hypertension was not related to the later development of hematoma, the researchers found the occurrence of hypertension in the postanesthesia unit was statistically significantly correlated with hematoma development.

Regardless of medical history, the researchers stated that it is essential for all patients to receive appropriate prophylactic hypertensive, anxiolytic and antiemetic treatment.

It was also recommended that patients with a history of hypertension seek assistance from their primary care physician for appropriate preoperative blood-pressure control. - by Abigail Sutton

Disclosures: Ramanadham reports no relevant financial disclosures. Please see the full study for a list of all other authors' relevant financial disclosures.