• #9-3. Management of anesthesia during plastic surgery


    Prevention of risk and complications


    Complications of sedatives and analgesics that lead to death commonly arise from hypoxia caused by respiratory suppression, airway obstruction, and cardiovascular collapse triggered by hypoxia, hypotension, and arrhythmia. Apnea, hypotension, post-surgical nausea and vomiting, post-surgical residual sedation, etc. are known common side effects. It is critical to prevent hypoxia that can lead to death or brain damage. ASA (American Society of Anesthesiologists) recommends providing oxygen with moderate or higher level of sedation. Moreover, patient’s medical history and airway conditions should be closely examined before surgery. Patients’ written consent should be collected after explanation about the risk and benefits of sedation anesthesia. The patient should also be instructed on the importance of fasting. Water, pulp-free juice, carbonated drinks, clear tea, and black coffee, etc. can be consumed in small amounts 2 hours before surgery. Light foods can be consumed 6 hours before surgery but heavy foods including meats have delayed gastric emptying and should not be consumed for an extensive period before surgery.


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    The likelihood of complications leading to death are associated with risk factors such as old age, and underlying gastrointestinal conditions including cardiovascular disease, pulmonary disease, kidney or liver disease, severe obesity, sleep apnea, and difficult airway, etc. Particular attention should be given to prevention of complications in these high-risk patients.

    Emergency equipment that are required for such complications include compressed oxygen device, aspirator, face mask, oral and nasal airway adjunct, automated respiration bag and valve, laryngoscope and  endotracheal tube, cardiopulmonary resuscitation drugs, and antagonists (flumazenil, naloxone).


    - To be continued


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