The purpose of this study was to determine the differences in measurable outcomes following aesthetic procedures performed under intravenous sedation with incremental doses of
midazolam and
fentanyl and those performed under
propofol infusion. The authors' hypothesis was that the differences in these outcome parameters are not significant between these intravenous sedation protocols. All intraoperative and perioperative records of 84 consecutive patients having aesthetic surgery under a
conscious sedation protocol using incremental doses of intravenous
midazolam and
fentanyl were retrospectively reviewed and compared with the records of a second group of 85 patients having aesthetic surgery under a
deep sedation regimen based primarily on
propofol infusion. All procedures were hospital based and performed by two surgeons. Twenty-eight different parameters were examined by chart review. In addition, a patient questionnaire was used to assess patient satisfaction and patient recall of operative and perioperative
pain, anxiety,
nausea, and
vomiting. Multivariate statistical analysis was conducted. The two sedation groups were similar with regard to aesthetic procedures performed and patient demographics. The mean duration of
operative time was statistically equivalent (152 minutes and 153 minutes). In both groups, there were minor adverse intraoperative events reported but no significant complications. Transient
hypotension was more common in the
propofol infusion group (12.9 percent versus 2.4 percent, p = 0.018), but no patient required intervention beyond reducing the
sedative agent or increasing intravenous fluids. The amount of supplemental
fentanyl given intraoperatively was significantly higher in the group whose primary agent for sedation was
propofol infusion than the group who received
midazolam/
fentanyl (209 mug and 143 mug, respectively). The overall questionnaire response rate was 80 percent for both groups. The
midazolam/
fentanyl sedation group had more recall of "unpleasant intraoperative events" (17 percent versus 3 percent, p = 0.007). However, both groups had low recall of intraoperative
pain, anxiety, and
nausea. The
propofol infusion group experienced significantly more
nausea in the recovery room (p = 0.002),
nausea at the time of discharge (p = 0.009), and
nausea the evening after the operation (p = 0.013). Greater than 90 percent of the patients in both groups would have the same
anesthetic in the future rather than undergo
general anesthesia. Patient safety, outcomes, and satisfaction are similar in
plastic surgery procedures performed under sedation protocols using either incremental doses of
midazolam and
fentanyl or
propofol infusion. All operative and postoperative outcomes for
pain, anxiety, and
vomiting were similar in the two groups except for immediate
postoperative nausea, which was higher in the
propofol infusion group. The overall satisfaction of patients undergoing
plastic surgery procedures under these intravenous sedation protocols appears very high.