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