Dexmedetomidine in aesthetic facial surgery: Improving anesthetic safety and efficacy

Background: Dexmedetomidine is an alpha(2)-agonist anesthetic with several properties that are advantageous in aesthetic facial surgery. By attenuating sympathetic nervous system activity, it induces sedation and analgesia while lowering blood pressure and preventing pain-induced hemodynamic fluctuations. It spares the respiratory drive and decreases the need for supplemental oxygen, thus reducing the fire risk of electrocautery. It decreases narcotic use, thereby further improving respiratory safety and decreasing postoperative nausea and vomiting. This retrospective study evaluated the safety and efficacy of dexmedetomidine in rhytidectomy. Methods: Records were reviewed for 155 consecutive face lifts performed under sedation by one surgeon over 3.5 years. Intraoperative and postoperative parameters and outcomes were compared for 78 patients sedated with dexmedetomidine (dexmedetomidine group) and 77 sedated without dexmedetomidine (no-dexmedetomidine group). Results: Intraoperatively, the dexmedetomidine group had lower mean systolic and diastolic blood pressures and heart rate (p < 0.001). Fewer dexmedetomidine group patients had oxygen desaturation below 92 percent (p < 0.05) and fewer required antihypertensives (p < 0.01), although more required vasopressors (p < 0.01). The dexmedetomidine patients needed less midazolam (p < 0.01) and fentanyl (p < 0.001). Postoperatively, the dexmedetomidine group again had lower mean systolic and diastolic blood pressures and heart rate (p < 0.001). In addition, fewer patients in this group needed postoperative antiemetics (p < 0.05). Immediate postoperative hematomas occurred in two patients in the dexmedetomidine group and one patient in the no-dexmedetomidine group. Conclusions: Dexmedetomidine lowered blood pressure, decreased the frequency of oxygen desaturations, and reduced narcotic, anxiolytic, and antiemetic use. When compared with conventional sedation, dexmedetomidine appears to I improve anesthetic safety and efficacy for rhytidectomy patients.