| PRS 0405-1807 Kryger
Kryger ZB, Fine NA, Mustoe TA.
The outcome of abdominoplasty performed under conscious sedation: six-year
experience in 153 consecutive cases. Plast Reconstr Surg. 2004 May;113(6):1807-17; discussion 1818-9.
Division of Plastic and Reconstructive Surgery, Feinberg School of Medicine,
Northwestern University Medical Center, 675 North St. Clair Street, Chicago, IL
60611, USA.
The use of conscious sedation is rapidly gaining acceptance and popularity in
plastic surgery. At the present time, many procedures are performed using
intravenous sedation and local anesthesia. The purpose of this article was to
examine the safety and outcome of full abdominoplasties performed under
conscious sedation at the authors' institution. Over a 6-year period from 1997
to 2002, 266 abdominoplasties were performed by the two senior authors. One
hundred thirteen of these (42 percent) were performed under a general or
regional anesthetic because a concurrent procedure was performed that precluded
the use of conscious sedation (64 hysterectomies, 18 hernia repairs, six
urogynecologic procedures, 10 breast reductions, and one laparoscopic
cholecystectomy) or because of patient and surgeon preference (14 cases). One
hundred fifty-three abdominoplasties (58 percent) were performed under conscious
sedation using intravenous midazolam and fentanyl along with a local anesthetic.
No patients had an unplanned conversion to deep sedation or general anesthesia.
Eighty percent of these cases were performed with a concurrent procedure (80
liposuctions, 19 breast augmentations, 20 mastopexies, three capsulotomies, and
13 varied facial aesthetic procedures). In addition, 12 patients had concurrent
hernia repairs (five ventral and seven umbilical) under conscious sedation. Mean
follow-up was 10 months (range, 1 to 56 months). There were no intraoperative
complications and no major postoperative complications. The minor complication
rate was 11.1 percent (10 seromas requiring needle aspiration in the office,
three superficial wound infections, two cases of marginal skin necrosis, one
stitch abscess, and one pseudobursa requiring reexcision). Seven revisions were
performed for suboptimal scars (5 percent). The results of this study
demonstrate that abdominoplasties can be performed under conscious sedation in a
safe and cost-effective manner for almost all patients. This type of procedure
is well tolerated, has a low complication rate, and has high patient
satisfaction. Increasing experience and small modifications in local anesthesia
and surgical technique have strengthened the authors' conviction that conscious
sedation is the preferred method of anesthesia for most patients undergoing
abdominoplasty.
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