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Anesthesia protocols and adverse events

Article-Anesthesia protocols and adverse events

Patients worry about anesthesia-related adverse effects, but does intravenous (IV) anesthesia really result in lower rates than traditional inhalational anesthesia (IA), as reported by a previously published IV protocol? Plastic surgeons Kristin A. Jones, M.D., Lexington, Ky., and Keith A. LaFerriere, M.D., Springfield, Mo., conducted a study to find out. Their study sought to evaluate postoperative outcomes in patients after administration of combined propofol and ketamine hydrochloride anesthesia with bispectral index monitoring (PKA-BIS protocol) as compared with IA during lower rhytidoplasty.

Drs. Jones and LaFerriere conducted a prospective, double-blind, randomized trial comparing the PKA-BIS protocol and IA in 30 consecutive female patients undergoing rhytidoplasty by a single surgeon at a single outpatient surgery center from October 2013 to June 2014. Outcome measures included nausea, vomiting, pain, overall feeling of well-being, time to awaken, time to discharge and cost. Patient measures were captured using a 40-item validated postoperative quality-of-recovery questionnaire (QOR-40) and visual analog scales (VASs). Results were recorded immediately after surgery and on the first and seventh postoperative days.

What They Found


What They Found

The authors observed a statistically significant reduction in emergence time and time needed to meet discharge criteria in PKA-BIS patients as compared with the IA group. They also found decreases in patient-reported postoperative nausea, vomiting and confusion on the day of surgery in the PKA-BIS group, though these differences were statistically insignificant. Differences in quality-of-recovery scores, postoperative overall feeling of well-being, and postoperative pain perception between the PKA-BIS and IA groups also were statistically insignificant. The costs of anesthesia administration were similar in both groups.

“The PKA-BIS protocol for anesthesia appears to be a comparable alternative to traditional IA in patients undergoing elective rhytidoplasty,” the authors write. “A larger patient sample size is needed to determine whether trends toward decreased nausea, vomiting and postoperative confusion and differences in postoperative pain perception are significant.”

The study was published in JAMA Plastic Surgery.

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