Plastic Surgery Procedural Videos
with Dr. Kenneth Benjamin Hughes
Dr. Kenneth Benjamin Hughes Providing the Best Plastic Surgery Results in Los Angeles Video
Dr. Kenneth Benjamin Hughes Breast Augmentation Revision Video
Dr. Kenneth Benjamin Hughes Liposuction and BBL for Thin Patient Video
Dr. Kenneth Benjamin Hughes Liposuction and Brazilian Buttlift Video
Dr. Kenneth Benjamin Hughes Liposuction Revision and Bodytite Video
Aesthetic Plastic Surgery: Safety for the Office Staff
Kenneth Hughes, MD
Division of Plastic and Reconstructive Surgery Beth Israel Deaconess Medical Center
Harvard University
Intended Audience
Office Staff
Including nurses, surgical technicians, and office managers
It is of paramount importance that all of the office personnel be focused on improving patient outcomes along with the plastic surgeon and anesthesia providers
Safety Measures Outline
Preoperative Safety Measures
Intraoperative Safety Measures and Protocols
Postoperative Safety Measures
Review Questions/Quiz
Preoperative Safety Measures
Most aesthetic plastic surgery candidates should have good general health and few, if any, comorbidities if they are to be done in the office setting
Additionally, some patient characteristics can disqualify the patient for the surgery, because the risk of complication is too high as to be acceptable to the plastic surgeon
These characteristics may vary based upon an individual surgeon’s technique and perspective
Preoperative Safety Measures
From the time the patient enters the office, certain key items should be identified
Tobacco, alcohol, or drug use
Nothing gets you taken off the OR schedule for a facelift faster than a smoking history
Preoperative Safety Measures
Allergies (not just medication but adhesives, skin prep, and latex)
It can be difficult to explain to a patient why she has partial thickness skin injury after a known offending adhesive was applied for dressings
Preoperative Safety Measures
Medications including birth control products (BCP), over the counter drugs (OTC), vitamins, and herbal preparations
Numerous herbal preparations can negatively impact clotting, while BCP put patients at risk for deep venous thrombosis and pulmonary thromboembolus
Immediate Preoperative Measures
Patients should be free of ingestion of clear liquids for 2 to 3 hours and of solids for 6 to 8 hours prior to induction
Patients should be normothermic prior to entering the operative suite
Preoperative warming should be performed to achieve normothermia
This issue is critically important in larger liposuction cases, body contouring cases, or during longer duration or multiple procedure cases
Immediate Preoperative Measures
The patient’s risk factors for deep venous thrombosis have been documented and prophylaxis has been administered
All patients should have some form of lower extremity venous compression devices that are started prior to induction of general anesthesia
Any patients with multiple risk factors should receive additional chemoprophylaxis (eg. Lovenox)
Special Mention for Abdominoplasty
This procedure is associated with the highest risk of deep venous thrombosis and pulmonary thromboembolus as reported in the literature
This procedure performed by itself or in conjunction with other procedures in most cases requires some form of chemoprophylaxis
Intraoperative Safety Measures
Assure that the compression devices continue to cycle
Everyone should perform periodic checks of the blood pressure, heart rate, and oxygen saturation
This is particularly true during and immediately following positioning changes and administration of local anesthesia
Fire Safety
Particularly during facial procedures, everyone must be aware of
1) Electrocautery use
2) Presence of combustible substances (i.e. drapes)
3) Presence of Oxygen
Fire Safety
If oxygen is being used, the source must be turned off for at least one minute before electrocautery is used
In most circumstances when electrocautery is to be used frequently, it is probably safer to not administer oxygen unless the patient’s condition mandates
Fire Safety
Skin preparatory agents should be dry or wiped dry
Wet sponges or towels can alleviate some of the risk
Emergency Protocols
There should be written protocols displayed prominently in the OR for cardiopulmonary emergencies
Everyone should know the protocols for the expeditious transfer of patients
Everyone should know the fire evacuation protocol
Postoperative Safety Measures
Attention to detail in the immediate postoperative period can be just as important as intraoperative and preoperative safety measures
The end of the surgery does not signal the end of vigilance for patient care
Postoperative Safety Measures
High blood pressure must be recognized and treated as it can lead to hematoma formation
Vomiting, coughing, as well as straining of any kind can lead to hematoma formation as well
Postoperative Safety Measures
Patient positioning is critical as well
Head elevation is important in any facial procedure (eg. facelift or rhinoplasty)
Patient positioning is also critical after abdominoplasty
-- patient should remain flexed at the waist to theoretically prevent wound separation
End of Presentation
Review Question #1
Lower extremity compression devices should be placed
A. After induction
B. Before induction
C. on a case by case basis
D. instead of Lovenox
Review Question #2
Fire safety involves awareness of all of the following except
A. Electrocautery
B. Oxygen
C. Drapes
D. Wet sponges
Review Question #3
High blood pressure has been shown to increase the rate of
A. Vomiting
B. Hematoma
C. Straining
D. Coughing
Review Question #4
Which of the following procedures has the highest risk of development of deep venous thrombosis?
A. Liposuction
B. Rhinoplasty
C. Abdominoplasty
D. Facelift
Review Question #5
Following the repositioning of the patient, which of the following should be closely monitored?
A. Blood loss
B. Urine volume
C. Temperature
D. Oxygen saturation