Optimal Use of Local Anesthetics and Tumescence

Abstract

It is mandatory for the cosmetic surgeon to use local anesthesia in a safe and effective manner. Current trends to perform more procedures in the office setting necessitate that the surgeon become facile with achieving anesthesia while minimizing complications. In a related theme, the use of tumescence during liposuction deserves respect, despite the ease with which it is applied. Too many unnecessary complications occur as a result of its careless use, resulting in a mortality rate higher than expected for an elective cosmetic procedure. Our goal is to describe the necessary characteristics, pharmacokinetics, physiologic effects, and overall safety guidelines for use of local anesthesia and tumescence. In addition, we highlight risk factors, newer anesthetics, and new methods for pain control.

A Detailed Cost and Efficiency Analysis of Performing Carpal Tunnel Surgery in the Main Operating Room versus the Ambulatory Setting in Canada

“…As the wide awake approach only uses lidocaine with epinephrine and no tourniquet (the same as is used in dental offices around the world), coexisting illness is seldom a concern except in patients with severe liver disease [5].…”

Tumescent anaesthesia for liposuction surgery—A review

“…It is noted that lidocaine levels peak at 8-16 h postoperatively which makes it imperative that patients who have been administered higher doses of lidocaine be monitored overnight for possible symptoms of lidocaine toxicity. 4 Lidocaine has bactericidal properties in undiluted solutions which improves at higher temperatures. 18 However, in diluted solutions as in tumescent formulation there is documented bacteriostatic effect.…”

“…Its use for liposuction has not been studied extensively probably due to its high cost, but in future this might prove to be a game changer for liposuction using tumescent local anaesthesia. 4…”

Pulmonary Delivery of Butyrylcholinesterase as a Model Protein to the Lung

“…19,20 These patients also suffer toxicity from common medicines, such as lidocaine and prilocaine. 21,22 To achieve efficient lung deposition of BuChE, we employed Particle Replication in Nonwetting Templates (PRINT) technology to fabricate BuChE particles for pulmonary delivery as a potential self-administered DPI. PRINT is a top-down particle fabrication technology that allows the engineering of precisely defined particles by exquisitely and independently controlling particle characteristics such as size, shape, chemical composition, and surface chemistry.…”

“…Pulmonary delivery is an emerging alterative therapeutic approach to the common parenteral route of administration for delivery of biologics. The lung enables local delivery with a large surface area for absorption of proteins, as well as potential for noninvasive systemic delivery. , Delivery of biologics, including active enzymes, to the lung is of particular interest for multiple diseases. For example, cystic fibrosis patients are currently treated with inhalation of rhDNase, an enzyme that aids in breaking down the sputum build up in the lungs .…”