Anesthesia for Liposuction and Abdominoplasty

Perioperative anesthetic management in liposuction surgery

“…It uses large volume (2-3 ml of infiltrating per 1ml of aspirate) of a mixture of lidocaine (the dosage used can be up to 35 mg/kg BW), adrenaline, and normal saline which are injected into the subcutaneous fat tissue to expand it and make it firm and turgid, before fat can be removed. 1,3,4 The tumescent liposuction technique in this case report used the modified infiltration solution by using normal saline infiltration only with the small dosage of epinephrine without lidocaine. Some data on anesthesia studies have revealed the use of lidocaine and epinephrine may result in toxicity in some cases, especially for the central nervous system and cardiac arrhythmia.…”

“…Invasive monitoring such as central venous pressure (CVP) line and arterial blood pressure are required for a morbidly obese patient (BMI ≥35kg/m 2 ) and undergoing large volume of liposuction (≥4.000 ml volume aspiration carried out). 4 The intraoperative fluid administration in the liposuction procedure is different from other surgeries where the total fluids received by the patient is a summation of intravenous fluids given by anesthesiologist and volume of wetting solution injected by the surgeon, meanwhile, the output includes the urine output and saline portion from wetting solution, fat, and blood in the lipoaspirate. 1,4 The residual volume is the difference between them, which remains in the extravascular compartment and acts as an interstitial infusion, thus any excess fluid administered can easily produce fluid overload (hypervolemic).…”

“…4 The intraoperative fluid administration in the liposuction procedure is different from other surgeries where the total fluids received by the patient is a summation of intravenous fluids given by anesthesiologist and volume of wetting solution injected by the surgeon, meanwhile, the output includes the urine output and saline portion from wetting solution, fat, and blood in the lipoaspirate. 1,4 The residual volume is the difference between them, which remains in the extravascular compartment and acts as an interstitial infusion, thus any excess fluid administered can easily produce fluid overload (hypervolemic). To limit the degree of fluid overloading and possibility of pulmonary edema, Rohrich et al suggested guidelines for intraoperative fluid resuscitation.…”

“…Appropriate precaution should be taken by carefully padding the sensitive pressure point such as elbow and heel in supine position. 2,3,4 Several precautions of some complications perioperative for liposuction also should be addressed. According to Grazer and De Jong have identified a total number of 130 deaths in almost 500,000 surgical procedure, of which the most important causes were thromboembolism (23.1%), abdomen or viscera perforation (14.6%), anesthesia/sedation/medication (10%), fat embolism (8.5%) and others (43.9%).…”

“…Meanwhile, the output includes the urine output and saline portion from the wetting solution, fat, and blood in the lipoaspirate. 1,4 The residual volume is the difference between them, which remains in the extravascular compartment and acts as an interstitial infusion, thus any excess of fluid administered can easily produce fluid overload, which is an important cause of morbidity in these obese patients, hence the accurate intake and output monitoring utilized must be made. 3 Eventually, postoperative care and monitoring include pain relief management and prevention of potential major complication, such as deep vein thrombosis (DVT), pulmonary embolism, fat…”