This article reviews the common pitfalls in the complex process of pre-operative assessment for facial plastic surgery. Legal guidelines and best practice are discussed, and attention is directed mainly towards the consenting and psychological issues surrounding this area of surgery.

Background and objective: The role of sevoflurane has not been studied in relation to awareness during anaesthesia. We observed the effect of sevoflurane on the incidence of awareness during cardiopulmonary bypass for open-heart surgery.

Methods: Fifty-nine patients of age >17 yr undergoing open-heart surgery with cardiopulmonary bypass were randomly assigned to two groups. In both groups, induction was with etomidate, dehydrobenzperidol and fentanyl; anaesthesia was maintained with sevoflurane, fentanyl and N2O; vecuronium was used for muscular paralysis. Group 1 (30 patients) received dehydrobenzperidol and fentanyl during cardiopulmonary bypass; Group 2 (29 patients) received sevoflurane and fentanyl. Patients were given different auditory inputs during different phases of surgery. All patients were interviewed with standard questions 8 and 24h postoperatively for evidence of explicit awareness.

Results: Five patients in the dehydrobenzperidol group gave a history of awareness (16.67%) as opposed to none in the sevoflurane group. The difference in the incidences of awareness was significant (P < 0.05), but no differences were found between the interviews conducted at 8 and 24h. Sevoflurane and opioid combination reduced the incidence of awareness in open-heart surgery.