Safety Profile of 4,397 Consecutive Intravenous Sedations in Office-Based Esthetic Surgery: A Single-Center Retrospective Audit.

BACKGROUND

Intravenous sedation (IVS) is widely used in office-based esthetic surgery, yet large-scale safety data from private clinics are scarce. This study quantified IVS utilization and evaluated perioperative safety in a high-volume Japanese cosmetic center.

METHODS

A retrospective review was conducted of all consecutive procedures performed under IVS between November 2020 and December 2024 at a single clinic. Eligibility was restricted to American Society of Anesthesiologists (ASA) class I-II patients. Propofol was the first-line sedative; midazolam was substituted for documented egg or soy allergy. Standard monitoring (ECG, noninvasive blood pressure, SpO2 alarm at 90 %) and a target Modified Observer's Assessment of Alertness/Sedation (MOAA/S) score of 2-3 were employed. Primary endpoints were major cardiopulmonary events (unplanned intubation, cardiac arrest). Secondary endpoints comprised intra-operative antihypertensive therapy, elective termination of sedation owing to paradoxical agitation, prolonged recovery (> 30 min to discharge readiness), and unplanned admission

RESULTS

A total of 4,397 IVS procedures were analyzed (female 89.7%, median age 39 years). Annual case volume rose from 41 (2020) to 1,753 (2024); combined procedures increased from 6.5 to 86.5 % over the same period. Propofol was used in 4,366 cases (99.3%); midazolam was administered in 31 allergy-screened cases (0.7%). No major cardiopulmonary events occurred (0%; 95% CI 0.00-0.08). Hypertensive episodes treated with intravenous nicardipine were observed in 44 cases (1.0%); no patient required supplemental oxygen. Sedation was electively discontinued for paradoxical agitation in 24 cases (0.55%). Prolonged recovery was recorded in 75 cases (1.7%); all patients were discharged on the same day. No unplanned admissions occurred.

CONCLUSIONS

Among 4,397 office-based esthetic procedures, IVS directed by non-anesthesiologist surgeons achieved a major complication rate of zero and a low incidence of minor events. Strict ASA I-II selection, continuous physiologic monitoring, and a weight-adjusted depth titration protocol can provide international-level safety in a private outpatient setting. Multicenter prospective studies are warranted to validate these findings and refine recovery benchmarks.

LEVEL OF EVIDENCE IV: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .