INTRODUCTION Total intravenous anesthesia may be beneficial for ambulatory aesthetic surgery with regard to quality of recovery, lack of complications and the ability to sustain an efficient discharge of patients. Safety and efficacy of TCI (Diprifusor TM) vs. manual controlled infusion of Propofol has been demonstrated. The combination of Propofol, analgesics/sedatives for outpatient conscious or unconscious sedation with an appropriate local anesthesia is analyzed for aesthetic surgery.

METHODS A retrospective review of 102 consecutive cases over a 12-month period (January 2001-2002) that underwent ambulatory aesthetic surgery is evaluated (ASA 1 and ASA 2). The mean age was 39.6 years and the average weight: 129.6 pounds (58.8 kg.).The procedures were performed under conscious or unconscious sedation. The routine procedure was: premedication with Midazolam (3mg), Meperol (50 mg.) in IV bolus, TCI Propofol induction dose: 3.60 g/ml, maintenance doses: 2.07 g/ml. Recovery time: 2 min.13 seconds. Local anesthesia was performed with lidocaine (1 to 0.12 %) with epinephrine.The endpoint of this study included: TCI Propofol dose required, benefits of the technique, side-effects, PONV, recovery time, discharge time, patient positions, oxygen administration or room air, patient’s comfort and analgesia required.

RESULTS: Surgical procedures were performed on prone and supine decubitus(including decubitus change in cases of Lipoplasty with patient cooperation), without intubation or laryngeal mask. Oxygen supply in almost all cases (92%) or room air at the discretion of the anesthesiologist to maintain normal oxygen tension (Fi02=0.3) with spontaneous ventilation. Mean drug consumption was 573.62 mg. of Propofol. Postoperative analgesia was required in 8 cases (7.84%), PONV in 3cases (2.94 %) and a discharge period of 2hours, 32 min. The mean time of the procedures was 1hour, 46 min. At the time of induction local anesthesia was performed .A careful and thorough infiltration procedure was necessary to avoid some body motion, although in all cases no recall of the procedure was reported with a pleasant awake.

CONCLUSION: A series of 102 consecutive patients using TCI Propofol, IV analgesics, and sedatives as premedication and careful local anesthesia was assessed in patients who underwent elective aesthetic surgery. Main hemodynamic parameters resulted particularly stable and the awakening times, which resulted brief and independent from the anesthesia duration, have been measured. With both sedation types (conscious or unconscious) this is a reliable method for ambulatory aesthetic surgery, without intubation, lower Propofol dose and excellent recovery in quality and time.The rapid elimination of currently available agents such as Propofol and in a predictable concentration with TCI equipments allows a quick recovery, although it needs a careful intra and postoperative monitoring of the patient.

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