![]() ![]() Oral opioids, which may be used as a pretreatment for awake plastic surgery, are limited in that they have a relatively slow onset. Adequate acute pain management is also important for avoiding the development of chronic pain. Patients who are comfortable during the procedure may be more willing to return to the clinic for additional procedures and may recommend the clinic to other potential patients. Adequate pain management is important so that the awake surgery is not disrupted, and the patient has a positive perioperative experience. However, more extensive and invasive procedures often require additional pain control. Local anesthetic infiltration may provide sufficient analgesia for certain limited awake procedures. Given its advantages, there is interest in using minimal sedation with a variety of plastic surgery procedures, including those that may result in substantial pain. 3, 7, 15 Older patients may prefer minimal sedation because of the desire to avoid postoperative delirium and the possible association between anesthesia and cognitive decline. 7, 12-14 Patients may prefer minimal sedation because of affordability, convenience, and fears of general anesthesia or deep sedation. 7 This is in part because nausea and vomiting are more common with deeper sedation and general anesthesia, 7, 12 contributing to longer recovery times, unintended hospital admissions, and complications such as hematoma and incisional dehiscence. 8-11 Furthermore, minimal sedation promotes an easier recovery than deeper levels of sedation. 7 Minimal sedation also helps to reduce the risk of serious adverse events associated with general anesthesia and deep sedation, which can include cardiovascular and respiratory complications. It reduces the cost of procedures compared with deep sedation or general anesthesia because of lower resource utilization. Minimal sedation can offer several advantages over deeper levels of sedation for various plastic surgery procedures. However, airway reflexes, spontaneous ventilation, and cardiovascular function are unaffected. Cognitive function and physical coordination may be affected. 6 With minimal sedation, patients respond normally to verbal commands. ![]() 3-5 Minimal sedation is the lowest level of sedation along the continuum of sedation/analgesia described by the American Society of Anesthesiologists ( Table 1). Plastic surgery procedures including liposuction and facial procedures can be performed with deep sedation or general anesthesia 1, 2 however, there has been an increasing trend for these procedures to be performed with local anesthesia and minimal sedation, in part due to patient preference for awake procedures. ![]()
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