The clinical outcome of abdominoplasty performed under conscious sedation:Increased use of fentanyl correlated with longer stay in outpatient unit

The objective of this study was to present data supporting the effectivenes s of performing mini and full abdominoplasties under conscious sedation wit h local anesthesia. The authors performed 20 such operations between 1994 and 1996, using a com bination of midazolam (Versed) and fentanyl instead of general anesthesia ( without art anesthesiologist or nurse anesthetist present). At 5- to 10-min ute intervals, the surgeon would order the injection of 1 cc (1 mg/ml) of m idazolam and 1 cc (50 mu g/ml) of fentanyl. The amount and the interval var ied based on the patient's level of sedation. Blood pressure, oxygen satura tion, and the patient's response to verbal and physical stimuli were used t o assess the sedation level. Average operating time was 147.5 minutes, and mean length of stay in the ou tpatient recovery room was 235.5 minutes. The average amounts of midazolam and fentanyl used were 9.4 mg (6 to 12.5 mg) and 532 mu g (300 to 800 mu g) , respectively. The average age of patients in this group was 41.7 years (2 8 to 63 years). Nineteen patients were discharged the same day. There were no surgical complications and no complication related to the sedation (such as respiratory or cardiac compromise). The average follow-up of these pati ents was 1.2 years (range, 3 to 21 months). Correlation coefficient rates a nd I-egression rates were calculated. The longer the procedure, the more mi dazolam was used intraoperatively (r = 0.5, p = 0.03). However, there was n o correlation between the length of the procedure and the amount of fentany l used. Rather, there was a positive correlation demonstrating that patient s who received more fentanyl stayed longer in the outpatient recovery area after surgery (r = 0.6, p < 0.01). The age of the patients and the amount o f midazolam did not correlate with how fast they went home from the outpati ent area. In conclusion, full and mini abdominoplasties can be performed safely using conscious sedation without compromising patient care or surgical outcome. Second, the survey revealed that patient satisfaction with these procedures performed under conscious sedation was very high. Third, the increased use of fentanyl, not midazolam, resulted in a longer stay in the outpatient un it after surgery. Nausea is a known side effect of narcotic analgesics, and it correlated with a higher dose of fentanyl administration in the patient s. The authors are now routinely administering a dose of either droperidol or odansetron (Zofran) preoperatively (both are antiemetics). Previously, t he ratio of midazolam and fentanyl injection was 1:1 every 5 to 10 minutes, but now it is 2:1 to 1:1 every 5 to 10 minutes (a smaller dose of fentanyl is administered). The conscious sedation technique should be an option for patients and plastic surgeons in academic and community hospital settings if they desire.