Liquid handling, lidocaine and epinephrine in liposuction. The properly form
Keywords:
Lipectomy, Pulmonary edema, Toxicity, Local anesthestics, Plastic Surgery
Abstract
Introduction: Fluid mismanagement in liposuction leads to pulmonary edema in a previously healthy individual. Pulmonary edema is considered the third cause of death in plastic surgery after PTE and lidocaine toxicity. The most important risk factor leading to this outcome is inadequate knowledge of fluid management and poor communication between the surgeon and the anaesthetist.
Objectives: To review the causes leading up to pulmonary edema in liposuction and the valid options for correct fluid management.
Methods: Non-systematic review of the literature in PubMed and Medline.
Results and conclusions: Correct fluid management in liposuction is based on a close communication between the surgeon and the anaesthetist in order to keep track of the total amount of subcutaneous fluid infiltration plus fluids delivered intravenously, always bearing in mind that infiltration fluids go to the central circulation.
References
1. Rohrich RJ, Beran SJ, Fodor PB. The role of subcutaneous infiltration in suction-assisted lipoplasty: a review. Plast Reconstr Surg. 1996;9:514.
2. Grazer FM, Meister FL. Factors contributing to adverse effects of the tumescent technique (surgical strategies). Aesthetic Surg J. 1997;7:411-6.
3. Klein JA. The tumescent technique for liposuction surgery. Am J Cosmetic Surg. 1987;4:263-6.
4. Trott SA, Beran SJ, Rohrich RJ, Kenkel JM, Adams WP, Klein KW. Safety considerations and fluid resuscitation in liposuction: an analysis of 53 consecutive patients. Plast Reconstr Surg. 1998;102:2220-5.
5. Burk RW, Guzman-Stein G, Vasconez LO. Lidocaine and epinephrine levels in tumescent technique liposuction. Plast Reconstr Surg. 1996;97:1379-85.
6. Klein JA. Tumescent technique for local anesthesia improves safety in large-volume liposuction. Plast Reconstr Surg. 1993;92:1085-90.
7. Burk RW, Guzman-Stein G, Vasconez LO. Lidocaine and epinephrine levels in tumescent technique liposuction. Plast Reconstr Surg. 1996;97:1379-84.
8. Klein JA. Tumescent technique for regional anesthesia permits lidocaine doses of 35 mg/kg for liposuction. J Dermatol Surg Oncol. 1990;16:248-52.
9. Ostad A, Kageyama N, Moy R. Tumescent anesthesia with a lidocaine dose of 55 mg/kg is safe for liposuction. Dermatol Surg. 1996;22:921-8.
10. Rohrich RJ, Jason E, Leedy, Swamy JR. Fluid resuscitation in liposuction: a retrospective review of 89 consecutive patients. Plast Reconstr Surg. 2006;117:431-6.
11. Arbous MS, Grobbee DE, van Kleef JW. Mortality associated with anaesthesia: a qualitative analysis to identify risk factors. Anaesthesia. 2001;56:1141-53.
12. Samdal F, Amland PF, Bugge JF. Blood loss during liposuction using the tumescent technique. Aesthetic Plast Surg. 1994;18:157-62.
13. Pitman GH, Aker JS, Tripp ZD. Tumescent liposuction. Clin Plast Surg. 1996;23:633-8.
14. Kenkel JM, Lipschitz AH, Luby M, Kallmeyer I. Hemodynamic physiology and thermoregulation in liposuction. Plast Reconstr Surg. 2004;114:503-13.
15. Brown SA, Lipschitz AH, Kenkel JM, et al. Pharmacokinetics and safety of epinephrine use in liposuction. Plast Reconstr Surg. 2004;114:756-65.
16. Rubin JP, Zhongcong X, Davidson Ch, et al. Rapid absorption of tumescent lidocaine above the clavicles: a prospective clinical study. Plast Reconstr Surg. 2005;115:1744-51.
17. Feisher LA. Risk of anesthesia. In: Miller RD, editor. Anesthesia. Churchill Livingstone; 2005. p. 893-920.
18. Hughes CE. Reduction of lipoplasty risks and mortality: an ASAPS survey. Ann Plast Surg. 2001;21:120-7.
19. Butterwick KJ, Goldman MP, Sriprachya-Anunt S. Lidocaine levels during the first two hours of infiltration of dilute anesthetic solution for tumescent liposuction: rapid versus slow delivery. Dermatol Surg. 1999;25:681-5.
20. Sweeney BP, Bromilow J. Liver enzyme induction and inhibition: implications for anaesthesia. Anaesthesia. 2006;61:159-77.
21. Rao RB, Ely SF, Hoffman RS. Deaths related to liposuction. N Engl J Med. 1999;340:1471-5.
22. Rohrich RJ, Kenkel JM, Jani JE, Beran SJ, Fodor PB. An update on the role of subcutaneous infiltration in suction-assisted lipoplasty. Plast Reconstr Surg. 2003;111:926-7, discussion 928.
23. Basile AR, Fernandes F, Basile VV, Basile FV. Fluid resuscitation in liposuction: a prospective analysis of infiltrate total-aspirate ratios lower than used for the super wet technique. Aesthetic Plast Surg. 2006;30:659-65, discussion 666.
24. Trott SA, Beran SJ, Rohrich RJ, Kenkel JM, Adams WP Jr, Klein KW. Safety considerations and fluid resuscitation in liposuction: an analysis of 53 consecutive patients. Plast Reconstr Surg. 1998;102:2220-9.
25. Jain AK, Khan AM, Asma MM. Stroke volume variation as a guide for fluid resuscitation in patients undergoing large-volume liposuction. Plast Reconstr Surg. 2012;130:462-9.
26. Reuter DA, Felbinger TW, Kilger E, Schmidt C, Lamm P, Goetz AE. Optimizing fluid therapy in mechanically ventilated patients after cardiac surgery by on-line monitoring of left ventricular stroke volume variations: a comparison to aortic systolic pressure variations. Br J Anaesth. 2002;88:124-6.
27. Reuter DA, Kirchner A, Felbinger TW, et al. Usefulness of left ventricular stroke volume variation to assess fluid responsiveness in patients with reduced cardiac function. Crit Care Med. 2003;31:1399-404.
28. de Jong RH, Grazer FM. Perioperative management of cosmetic liposuction. Plast Reconstr Surg. 2011;107:1039-44.
29. Pitman GH, Aker JS, Tripp ZD. Tumescent liposuction: a surgeon's perspective. Clin Plast Surg. 1996;23:633-41.
30. Sasaki GH, Tevez A. Larger infiltration/aspiration volumes, plasma/subcutaneous fluid lidocaine levels and quantitative abdominal tissue accommodation after water-assisted liposuction (WAL): comparative safety and efficacy to traditional liposuction (TL) in advanced techniques in liposuction and fat transfer. 11th ed; 2011. p. 81-94.
31. Grazer FM, de Jong RH. Fatal outcomes from liposuction: census survey of cosmetic surgeons. Plast Reconstr Surg. 2000;105:436-42.
32. Barillo DJ, Cancio LC, Kim SH, et al. Fatal and near fatal complications of liposuction. South Med J. 1998;91:487-94.
33. Gorney M. Suction-assisted lipoplasty: complications and fatal outcomes. In: Presented at the annual meeting of the American Society of Plastic and Reconstructive Surgeons. 1998.
34. Gingrass MG. Lipoplasty complications and their prevention. Clin Plast Surg. 1999;26:341-9.
35. de Jong RH, Grazer FM. Tumescent liposuction alert: deaths from lidocaine cardiotoxicity. Am J Forensic Med Pathol. 1999;20:100-7.
36. Platt MS, Kohler LJ, Ruiz R, et al. Deaths associated with liposuction: case reports and review of the literature. J Forensic Sci. 2002;47:205-9.
37. American Society of Plastic Surgeons. Procedural Statistics Report. Arlington Heights Ill. American Society of Plastic Surgeons; 2001.
38. Klein JA. The tumescent technique: anesthesia and modified liposuction technique. Dermatol Clin. 1990;8:425-32.
39. Samdal F, Amland PF, Bugge JF. Blood loss during liposuction using the tumescent technique. Aesthetic Plast Surg. 1994;18:157-63.
40. Lillis PJ. Liposuction surgery under local anesthesia: limited blood loss and minimal lidocaine absorption. J Dermatol Surg Oncol. 1988;14:1145-52.
41. Iverson RE. Patient safety in office-based surgery facilities: 1. Procedures in the office-based surgery setting. Plast Reconstr Surg. 2002;110:1337-45.
42. Sessler DI. Perioperative heat balance. Anesthesiology. 2000;92:578-84.
43. Yamakage MY, Kamada Y, Homma Y, Tsujiguchi N, Namiki A. Predictive variables of hypothermia in the early phase of general anesthesia. Anesth Analg. 2000;90:456-63.
44. Alfonsi P. Postanesthetic shivering: epidemiology, pathophysiology, and approaches to prevention and management. Drugs. 2001;61:2193-9.
45. Scheeren TW. Relation between oxygen consumption and cardiac output during inhalation anesthesia under the influence of catecholamines: a study in dogs. Anasthesiol Intensivmed Notfallmed Schmerzther. 2000;35:214-22.
46. Hoffman BB. Catecholamines, sympathomimetic drugs and adrenergic receptors antagonists. In: Hardman JG, Limbird LE, Gilman AG, editors. The pharmacological basis of therapeutics. 10th ed. New York: McGraw-Hill; 2001. p. 215-68.
47. Cheung PY, Barrington KJ. The effects of dopamine and epinephrine on hemodynamics and oxygen metabolism in hypoxic anesthetized piglets. Crit Care. 2001;5:158-65.
2. Grazer FM, Meister FL. Factors contributing to adverse effects of the tumescent technique (surgical strategies). Aesthetic Surg J. 1997;7:411-6.
3. Klein JA. The tumescent technique for liposuction surgery. Am J Cosmetic Surg. 1987;4:263-6.
4. Trott SA, Beran SJ, Rohrich RJ, Kenkel JM, Adams WP, Klein KW. Safety considerations and fluid resuscitation in liposuction: an analysis of 53 consecutive patients. Plast Reconstr Surg. 1998;102:2220-5.
5. Burk RW, Guzman-Stein G, Vasconez LO. Lidocaine and epinephrine levels in tumescent technique liposuction. Plast Reconstr Surg. 1996;97:1379-85.
6. Klein JA. Tumescent technique for local anesthesia improves safety in large-volume liposuction. Plast Reconstr Surg. 1993;92:1085-90.
7. Burk RW, Guzman-Stein G, Vasconez LO. Lidocaine and epinephrine levels in tumescent technique liposuction. Plast Reconstr Surg. 1996;97:1379-84.
8. Klein JA. Tumescent technique for regional anesthesia permits lidocaine doses of 35 mg/kg for liposuction. J Dermatol Surg Oncol. 1990;16:248-52.
9. Ostad A, Kageyama N, Moy R. Tumescent anesthesia with a lidocaine dose of 55 mg/kg is safe for liposuction. Dermatol Surg. 1996;22:921-8.
10. Rohrich RJ, Jason E, Leedy, Swamy JR. Fluid resuscitation in liposuction: a retrospective review of 89 consecutive patients. Plast Reconstr Surg. 2006;117:431-6.
11. Arbous MS, Grobbee DE, van Kleef JW. Mortality associated with anaesthesia: a qualitative analysis to identify risk factors. Anaesthesia. 2001;56:1141-53.
12. Samdal F, Amland PF, Bugge JF. Blood loss during liposuction using the tumescent technique. Aesthetic Plast Surg. 1994;18:157-62.
13. Pitman GH, Aker JS, Tripp ZD. Tumescent liposuction. Clin Plast Surg. 1996;23:633-8.
14. Kenkel JM, Lipschitz AH, Luby M, Kallmeyer I. Hemodynamic physiology and thermoregulation in liposuction. Plast Reconstr Surg. 2004;114:503-13.
15. Brown SA, Lipschitz AH, Kenkel JM, et al. Pharmacokinetics and safety of epinephrine use in liposuction. Plast Reconstr Surg. 2004;114:756-65.
16. Rubin JP, Zhongcong X, Davidson Ch, et al. Rapid absorption of tumescent lidocaine above the clavicles: a prospective clinical study. Plast Reconstr Surg. 2005;115:1744-51.
17. Feisher LA. Risk of anesthesia. In: Miller RD, editor. Anesthesia. Churchill Livingstone; 2005. p. 893-920.
18. Hughes CE. Reduction of lipoplasty risks and mortality: an ASAPS survey. Ann Plast Surg. 2001;21:120-7.
19. Butterwick KJ, Goldman MP, Sriprachya-Anunt S. Lidocaine levels during the first two hours of infiltration of dilute anesthetic solution for tumescent liposuction: rapid versus slow delivery. Dermatol Surg. 1999;25:681-5.
20. Sweeney BP, Bromilow J. Liver enzyme induction and inhibition: implications for anaesthesia. Anaesthesia. 2006;61:159-77.
21. Rao RB, Ely SF, Hoffman RS. Deaths related to liposuction. N Engl J Med. 1999;340:1471-5.
22. Rohrich RJ, Kenkel JM, Jani JE, Beran SJ, Fodor PB. An update on the role of subcutaneous infiltration in suction-assisted lipoplasty. Plast Reconstr Surg. 2003;111:926-7, discussion 928.
23. Basile AR, Fernandes F, Basile VV, Basile FV. Fluid resuscitation in liposuction: a prospective analysis of infiltrate total-aspirate ratios lower than used for the super wet technique. Aesthetic Plast Surg. 2006;30:659-65, discussion 666.
24. Trott SA, Beran SJ, Rohrich RJ, Kenkel JM, Adams WP Jr, Klein KW. Safety considerations and fluid resuscitation in liposuction: an analysis of 53 consecutive patients. Plast Reconstr Surg. 1998;102:2220-9.
25. Jain AK, Khan AM, Asma MM. Stroke volume variation as a guide for fluid resuscitation in patients undergoing large-volume liposuction. Plast Reconstr Surg. 2012;130:462-9.
26. Reuter DA, Felbinger TW, Kilger E, Schmidt C, Lamm P, Goetz AE. Optimizing fluid therapy in mechanically ventilated patients after cardiac surgery by on-line monitoring of left ventricular stroke volume variations: a comparison to aortic systolic pressure variations. Br J Anaesth. 2002;88:124-6.
27. Reuter DA, Kirchner A, Felbinger TW, et al. Usefulness of left ventricular stroke volume variation to assess fluid responsiveness in patients with reduced cardiac function. Crit Care Med. 2003;31:1399-404.
28. de Jong RH, Grazer FM. Perioperative management of cosmetic liposuction. Plast Reconstr Surg. 2011;107:1039-44.
29. Pitman GH, Aker JS, Tripp ZD. Tumescent liposuction: a surgeon's perspective. Clin Plast Surg. 1996;23:633-41.
30. Sasaki GH, Tevez A. Larger infiltration/aspiration volumes, plasma/subcutaneous fluid lidocaine levels and quantitative abdominal tissue accommodation after water-assisted liposuction (WAL): comparative safety and efficacy to traditional liposuction (TL) in advanced techniques in liposuction and fat transfer. 11th ed; 2011. p. 81-94.
31. Grazer FM, de Jong RH. Fatal outcomes from liposuction: census survey of cosmetic surgeons. Plast Reconstr Surg. 2000;105:436-42.
32. Barillo DJ, Cancio LC, Kim SH, et al. Fatal and near fatal complications of liposuction. South Med J. 1998;91:487-94.
33. Gorney M. Suction-assisted lipoplasty: complications and fatal outcomes. In: Presented at the annual meeting of the American Society of Plastic and Reconstructive Surgeons. 1998.
34. Gingrass MG. Lipoplasty complications and their prevention. Clin Plast Surg. 1999;26:341-9.
35. de Jong RH, Grazer FM. Tumescent liposuction alert: deaths from lidocaine cardiotoxicity. Am J Forensic Med Pathol. 1999;20:100-7.
36. Platt MS, Kohler LJ, Ruiz R, et al. Deaths associated with liposuction: case reports and review of the literature. J Forensic Sci. 2002;47:205-9.
37. American Society of Plastic Surgeons. Procedural Statistics Report. Arlington Heights Ill. American Society of Plastic Surgeons; 2001.
38. Klein JA. The tumescent technique: anesthesia and modified liposuction technique. Dermatol Clin. 1990;8:425-32.
39. Samdal F, Amland PF, Bugge JF. Blood loss during liposuction using the tumescent technique. Aesthetic Plast Surg. 1994;18:157-63.
40. Lillis PJ. Liposuction surgery under local anesthesia: limited blood loss and minimal lidocaine absorption. J Dermatol Surg Oncol. 1988;14:1145-52.
41. Iverson RE. Patient safety in office-based surgery facilities: 1. Procedures in the office-based surgery setting. Plast Reconstr Surg. 2002;110:1337-45.
42. Sessler DI. Perioperative heat balance. Anesthesiology. 2000;92:578-84.
43. Yamakage MY, Kamada Y, Homma Y, Tsujiguchi N, Namiki A. Predictive variables of hypothermia in the early phase of general anesthesia. Anesth Analg. 2000;90:456-63.
44. Alfonsi P. Postanesthetic shivering: epidemiology, pathophysiology, and approaches to prevention and management. Drugs. 2001;61:2193-9.
45. Scheeren TW. Relation between oxygen consumption and cardiac output during inhalation anesthesia under the influence of catecholamines: a study in dogs. Anasthesiol Intensivmed Notfallmed Schmerzther. 2000;35:214-22.
46. Hoffman BB. Catecholamines, sympathomimetic drugs and adrenergic receptors antagonists. In: Hardman JG, Limbird LE, Gilman AG, editors. The pharmacological basis of therapeutics. 10th ed. New York: McGraw-Hill; 2001. p. 215-68.
47. Cheung PY, Barrington KJ. The effects of dopamine and epinephrine on hemodynamics and oxygen metabolism in hypoxic anesthetized piglets. Crit Care. 2001;5:158-65.
How to Cite
1.
Bayter Marin JE. Liquid handling, lidocaine and epinephrine in liposuction. The properly form. Colomb. J. Anesthesiol. [Internet]. 2015 Jan. 1 [cited 2024 Apr. 26];43(1):95-100. Available from: https://www.revcolanest.com.co/index.php/rca/article/view/491
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2015-01-01
How to Cite
1.
Bayter Marin JE. Liquid handling, lidocaine and epinephrine in liposuction. The properly form. Colomb. J. Anesthesiol. [Internet]. 2015 Jan. 1 [cited 2024 Apr. 26];43(1):95-100. Available from: https://www.revcolanest.com.co/index.php/rca/article/view/491
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Narrative review
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