Atenolol prevents the formation of expansive hematoma after rhytidoplasty

Moreira, Amanda Castilho; Moreira, Marcio; Gurgel, Sanderland José Tavares; Moreira, Yasmin Castilho; Martins, Eguimar Roberto; Hartmann, R; Fagundes, Djalma José

doi:10.1590/0100-69912014005002

Cited by 9 publications

(12 citation statements)

References 28 publications

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“…Clonidine or beta-blockers (Atenolol) to control arterial blood pressure (3,12). The adrenaline injected in the local anaesthesia solution is slowly resorbed and the vasoconstrictive action continues for 4 to 10 hours (8).…”

Section: Discussionmentioning

confidence: 99%

The cervicofacial lift under pure local anaesthesia diminishes the incidence of post-operative haematoma

Moris

Bensa²,

Gerenton

et al. 2019

Journal of Plastic, Reconstructive & Aesthetic Surgery

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The cervicofacial lift is a frequently performed procedure in plastic surgery. It is the reference technique for facial rejuvenation and restoration of the oval form of the face and it is essential to treat excess skin. One of the most frequent complications of this procedure is the formation of haematomas. The aim of this article is to analyze the incidence of bleeding in the standard cervicofacial lift carried out under pure local anaesthesia. The entire operation, including liposuction and tightening of the SMAS, can be done under local anaesthesia. A total of 1500 patients, who have undergone cervicofacial lift under pure local anaesthesia between November 1995 and January 2016, were included in the study. The incidence of early bleeding (in the first 15 days following the operation) was recorded and analyzed. Pre-intra-and postoperative monitoring of the arterial blood pressure revealed stable pressure in the peri-operative period. The mean difference in blood pressure when comparing the intraoperative to the postoperative periods was 7 mmHg for the systolic BP [range from 3 -25] and 4 mmHg [range from 2 -12] for the diastolic BP, with lower mean values in the postoperative period. We identified nine bleeding events in 1500 patients (0.6%). The cervicofacial lift under pure local anaesthesia does not radically modify the surgical technique. It allows better control of arterial blood pressure of patients throughout the surgical procedure and avoids fluctuations in blood pressure, which is one of the main causes of bleeding and haematoma formation. The infiltration of xylocaine adrenaline combined with the absence of hypotensive general anaesthesia diminishes the incidence of haematoma and ensures an early return home for the patients.

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Section: Discussionmentioning

confidence: 99%

The cervicofacial lift under pure local anaesthesia diminishes the incidence of post-operative haematoma

Moris

Bensa²,

Gerenton

et al. 2019

Journal of Plastic, Reconstructive & Aesthetic Surgery

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“…These findings are similar to those of Killion et al 69 in their systematic review, which found hematoma 4 times less likely but equivalent seroma rates when fibrin glue was used. Moreira et al 71 found that administering atenolol preoperatively with the goal of a resting heart rate of 60/min or less significantly reduced the rate of hematoma in their study of 80 patients (40 in each cohort). The Cochrane Review meta-analysis by da Silva et al 70 on the use of corticosteroids to prevent complications after facial plastic surgery was also included, because the authors separated the data relating to intervention.…”

Section: Evidence Levelmentioning

confidence: 92%

“…Four of the studies related to the efficacy and safety of tissue sealants, [66][67][68][69] 1 study concerned the use of corticosteroids in facial rejuvenation surgery, 70 and 1 study concerned the perioperative use of atenolol to prevent hematoma. 71 Hester et al 66,67 reported on 2 randomized clinical trials (phase 2 and 3) that evaluated the safety and efficacy of adjuvant fibrin sealant and found decreased rates of drainage when fibrin sealant was used compared with standard of care, with no significant difference in the rate of hematoma, seroma, or ecchymosis. Giordano et al 68 performed a systematic review and meta-analysis related to the use of tissue sealants and found statistically significant decreased rates of postoperative hematoma, wound drainage, and edema but not of ecchymosis, seroma, skin necrosis, or scarring.…”

Section: Evidence Levelmentioning

confidence: 99%

“…An additional study, which did not evaluate anesthetic technique but preoperative antihypertensive administration, also showed impressive results. Moreira et al 71 used preoperative oral atenolol to titrate patients' heart rates to less than 60/min before undergoing rhytidectomy. They demonstrated a statistically significant decrease in hematoma formation (4 vs 0 events; P < .001).…”

Section: Anesthetic Techniques and Hypertension Managementmentioning

confidence: 99%

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Advances in Face-lift Techniques, 2013-2018

Floyd

Sukato

Perkins

2019

JAMA Facial Plast Surg

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IMPORTANCE Rhytidectomy, or face-lift surgery, is the mainstay of facial rejuvenation and is constantly evolving. There is continuous research to improve outcomes and minimize complications of this surgery.OBJECTIVE To synthesize the updated techniques in rhytidectomy published during the past 5 years, including surgical technique, advances in anesthetic technique, minimally invasive techniques, and adjunctive procedures performed at the time of rhytidectomy.EVIDENCE REVIEW On February 8, 2018, a literature search was performed of the PubMed and Cochrane databases using the search terms, face-lift or rhytidectomy and techniques. Articles published from February 8, 2013, to February 8, 2018, that related to techniques of facial rejuvenation in the lower one-third of the face by lifting and supporting tissue with 5 or more patients were included. Systematic reviews and primary literature were considered; narrative reviews, validation studies, and anatomic studies were eliminated. The initial search resulted in 604 articles after duplicates were removed. This was reduced to 84 articles after dual independent review screening.FINDINGS Of the 84 articles included, 51 (61%) regarding techniques of face-lifting in the past 5 years pertained to soft-tissue techniques; 14 (17%) pertained to implants or adjunctive medications, such as tissue sealants; and 12 (14%) related to adjunctive techniques performed in addition to face-lifting, such as fat grafting, resurfacing, and liposuction. All studies found the techniques reported therein to be effective, with similar or fewer complications compared with the literature. However, according to the Oxford Centre for Evidence-Based Medicine criteria, the level of evidence of the studies was generally poor, because 45 of the studies (54%) were case series (level 4 of evidence).CONCLUSIONS AND RELEVANCE Several new techniques have been explored for rhytidectomy or face-lift in the past 5 years, including soft-tissue techniques, introduction of implants or topical medications such as tissue sealants, and concomitant adjunctive techniques to enhance results. The overall quality of the evidence is poor, with most articles using case series with nonvalidated measures to evaluate outcomes. There is considerable room for improvement in the literature if additional studies using cohort designs and validated outcomes are performed to validate the quality of the techniques introduced during the past 5 years.

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“…Remaining identified studies addressed various other adjunctive measures, but in our view presented too few studies and/ or insufficient strength of evidence upon which to form an opinion as to their safety and effectiveness. This group included adjunctive measures directed at hematoma prevention (perioperative atenolol, 43 percutaneous quilting sutures, 44 and PRP 45 ) and those aimed at improving the longevity (GalaFlex 46 ) or cosmetic outcome (Liposuction, 47 barbed threads 48 ) of conventional facelift techniques.…”

Section: Other Adjunctsmentioning

confidence: 99%

The Evidence for Adjunctive Facelift Procedures

2018

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Facelift surgery is a popular treatment but exhibits high variation among practitioners in terms of both core technique and adjunctive measures. This review identified significant evidence addressing the role of pre-infiltration, drains, fat grafting, fibrin tissue adhesives, hilotherapy, and other miscellaneous adjuncts. Based on the authors' assessment of the current literature, there is reasonable supportive evidence for pre-infiltration, fat grafting and laser skin resurfacing, which appear to be safe and effective in appropriately selected patients. Drain use is not mandatory but may confer some benefit. Conversely the evidence for the use of fibrin tissue adhesives and hilotherapy is not compelling.

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Atenolol prevents the formation of expansive hematoma after rhytidoplasty

Abstract: The perioperative use of atenolol caused a decrease in blood pressure and heart rate and decreased the incidence of expanding hematoma after rhytidectomy.

Cited by 9 publications

References 28 publications

The cervicofacial lift under pure local anaesthesia diminishes the incidence of post-operative haematoma

The cervicofacial lift under pure local anaesthesia diminishes the incidence of post-operative haematoma

Advances in Face-lift Techniques, 2013-2018

The Evidence for Adjunctive Facelift Procedures

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