Safety of Depth-Adjusted Intravenous Anesthesia in Office-Based Aesthetic Surgery: A One-Month Prospective Study of 135 Consecutive Cases.

backgroundOffice-based aesthetic surgery frequently relies on intravenous anesthesia to balance intraoperative comfort with rapid recovery. While large series suggest low complication rates, prospective data on patient-reported outcomes under standardized, depth-adjusted protocols remain limited. This study prospectively evaluated safety, satisfaction, recall, and recovery using the specialist-led UMEDA protocol.

methodsIn a single-center, prospective observational study, all consecutive adults undergoing office-based aesthetic procedures between May 1-31, 2025 were analyzed (N = 135). Intravenous anesthesia followed the UMEDA (Ultra-safe Method for Elective Depth-adjusted Anesthesia) protocol; monitoring included automated noninvasive blood pressure, heart rate, and pulse oximetry at 5-min intervals. Anesthesia was predominantly propofol-based (133/135), with midazolam used only in patients with a history of allergy to propofol formulation components (2/135). Primary endpoint was patient satisfaction (5-point Likert). Secondary endpoints were intraoperative recall, recovery time, and major cardiorespiratory events. Two prespecified multivariable logistic regressions examined predictors of (1) high satisfaction (score = 5) and (2) continuous recall.

resultsNo major cardiorespiratory events occurred. Median satisfaction was 5 [IQR 4-5]; 68.1% rated 5. Intraoperative recall was "none" in 38.5%, "induction/emergence only" in 47.4%, and "continuous" in 14.1%. Median recovery time was 22 min [13.0-36.0]. In the satisfaction model, female sex independently predicted high satisfaction (aOR 3.31; 95% CI 1.04-10.50; p = 0.042); age, operative time, recovery time, weight-adjusted propofol dose, multiple procedures, and continuous infusion were not significant (all VIF<5). In the recall model, higher weight-adjusted propofol dose independently reduced the odds of continuous recall (aOR 0.07; 95% CI 0.01-0.67; p = 0.021); sex was not significant (all VIF < 2).

conclusionsIn 135 consecutive office-based cases managed with the UMEDA protocol, depth-adjusted intravenous anesthesia was delivered safely with very high satisfaction, low rates of persistent intraoperative recall, and rapid recovery. These findings support safe and effective implementation of specialist-led, depth-adjusted intravenous anesthesia in ambulatory aesthetic practice and motivate multicenter validation. 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 .