Factors contributing to adverse effects of the tumescent technique*

Liquid handling, lidocaine and epinephrine in liposuction. The properly form

“…This induces significant changes in fluid behaviour inside the compartment, with the risk of pulmonary oedema and heart failure. 2 Added to the invention by Klein in 1987 of a tumescent solution that included 500-1000 mg of lidocaine plus 1 mg of epinephrine for every 1000 cc of NSS 3 (Fig. 1) and which is widely used today for subcutaneous infiltration, the risk of lidocaine toxicity is a reality and the second cause of death in plastic surgery according to the American Society of Plastic Surgeons (ASPS).…”

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)

“…Since most of the infiltrate, ranging from 22-29 percent, is not removed by suctioning, at least 70 percent of the infiltrate is believed to remain after the procedure 20,49 . Fluid overload 28,33,41,[51][52][53] becomes possible whenever substantial amounts of tumescent infiltrative fluids or parenteral fluids are used in high volume cases with the tumescent (3-4:1 ratio) and superwet (1-1.5:1) techniques. Since WAL's variable force infusion pump pulses fan-shaped jets of tumescent solution into the subcutaneous fatty tissue during its three procedural phases, but only suctions simultaneously the loosened fat and fluid during the latter two phases, the final physiological and pharmacological impact is expected to reflect more closely the infiltrationto-aspiration ratios (between 3-4:1) observed with the tumescent technique.…”