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Arch Plast Surg > Volume 46(3); 2019 > Article
Archives of Plastic Surgery 2019;46(3):189-197.
DOI: https://doi.org/10.5999/aps.2018.01473    Published online May 15, 2019.
Safe anesthesia for office-based plastic surgery: Proceedings from the PRS Korea 2018 meeting in Seoul, Korea
Brian M. Osman1  , Fred E. Shapiro2 
1Department of Anesthesiology, Perioperative Medicine and Pain Management, University of Miami, Miller School of Medicine, Miami, FL, USA
2Department of Anesthesiology, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
Correspondence:  Brian M. Osman, Tel: +1-305-689-2376, Fax: +1-305-689-1085, 
Email: bosman@med.miami.edu
Received: 14 December 2018   • Revised: 2 March 2019   • Accepted: 2 March 2019
Abstract
There has been an exponential increase in plastic surgery cases over the last 20 years, surging from 2.8 million to 17.5 million cases per year. Seventy-two percent of these cases are being performed in the office-based or ambulatory setting. There are certain advantages to performing aesthetic procedures in the office, but several widely publicized fatalities and malpractice claims has put the spotlight on patient safety and the lack of uniform regulation of office-based practices. While 33 states currently have legislation for office-based surgery and anesthesia, 17 states have no mandate to report patient deaths or adverse outcomes. The literature on office-base surgery and anesthesia has demonstrated significant improvements in patient safety over the last 20 years. In the following review of the proceedings from the PRS Korea 2018 meeting, we discuss several key concepts regarding safe anesthesia for officebased cosmetic surgery. These include the safe delivery of oxygen, appropriate local anesthetic usage and the avoidance of local anesthetic toxicity, the implementation of Enhanced Recovery after Surgery protocols, multimodal analgesic techniques with less reliance on narcotic pain medications, the use of surgical safety checklists, and incorporating “the patient” into the surgical decision-making process through decision aids.
Keywords: Plastic surgery / Office-based anesthesia / Enhanced recovery after surgery / Checklist / Decision aids
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