Anesthetic Techniques for Liposuction
It is optimally important for anesthesiologists to comprehend the fluid management techniques of liposuction in a proper way to avoid unpleasant circumstances. Besides, it is necessary to have a meticulous check on the pathophysiology of obesity to diminish the risks of complications considerably.
Liposuction techniques can be categorized into four types based on the quantity of wetting solution (or infiltration) injected and the blood loss that takes place (calculated as a percentage of aspirated fluid). The techniques include:
And
Important Aspects of Tumescent Technique
Coined by Klein, the term "tumescent technique" refers to swelling (tumescence means "to swell"). The technique involves injection of huge volumes of local anesthesia and additives, which include sodium bicarbonate and epinephrine. The solution is administered inside the subcutaneous tissue, which leads to its expansion making it firmer, swollen and more turgid. This, in turn, creates a plane, which facilitates quick suction of fat.
Liposuction is of two kinds based on the volume of aspiration.
High volume liposuction exhibits risk of pulmonary oedema as in this kind of liposuction apart from huge tissue removal, large fluid shifts also take place. Hence, the surgeon should use intravenous fluids very cautiously while carrying out high-volume liposuction.
Klein and Hunstad have proposed some of the common as well as functional wetting solutions. They include:
Local anesthesia can be diluted in two types of solutions, isotonic saline (0.9%) and lactated Ringer's solution. While isotonic solution may give a burning sensation, the lactated Ringer's solution does not cause any such skin irritation.
The most common form of local anesthetic is Lignocaine, the concentration of which depends largely on the vascularity of the region where liposuction is to be carried out. Generally, the maximum dose recommended to most patients is 55mg per kg while for patients undergoing liposuction the dose varies around 35 to 55mg per kg.
However, for more vascular regions like abdomen and breast, an increased dose of 1500 mg per litre can be administered, whereas for not so sensitive areas like thighs the dose is lessened to 500 mg per litre of normal saline. This runs out any risk of lignocaine intoxication enabling infusion of large quantity of wetting solution.
Apart from lignocaine, two other anesthetics that can be used in tumescent solutions are Prilocaine and Articaine. Sodium bicarbonate solution is used as a buffer to decrease the burning sensation that might occur when tumescent solution is injected. It also enables rapid entry of the tumescent solution in the nerve by increasing its pH level. Sometimes steroids are also added to the solution owing to the beneficial effect of their anti-inflammatory property as well as stabilizing characteristic.
Liposuction techniques can be categorized into four types based on the quantity of wetting solution (or infiltration) injected and the blood loss that takes place (calculated as a percentage of aspirated fluid). The techniques include:
- Ø Tumescent Technique (the most common of all)
- Ø Dry Technique
- Ø Wet Technique
And
- Ø Super wet Technique
Important Aspects of Tumescent Technique
Coined by Klein, the term "tumescent technique" refers to swelling (tumescence means "to swell"). The technique involves injection of huge volumes of local anesthesia and additives, which include sodium bicarbonate and epinephrine. The solution is administered inside the subcutaneous tissue, which leads to its expansion making it firmer, swollen and more turgid. This, in turn, creates a plane, which facilitates quick suction of fat.
Liposuction is of two kinds based on the volume of aspiration.
- Ø High Volume liposuction (includes more than 4,000 ml of aspiration)
- Ø Low volume liposuction (includes less than 4,000 ml of aspiration)
High volume liposuction exhibits risk of pulmonary oedema as in this kind of liposuction apart from huge tissue removal, large fluid shifts also take place. Hence, the surgeon should use intravenous fluids very cautiously while carrying out high-volume liposuction.
Klein and Hunstad have proposed some of the common as well as functional wetting solutions. They include:
- Ø Crystalloid Solutions
Local anesthesia can be diluted in two types of solutions, isotonic saline (0.9%) and lactated Ringer's solution. While isotonic solution may give a burning sensation, the lactated Ringer's solution does not cause any such skin irritation.
- Ø Local Anesthetics
The most common form of local anesthetic is Lignocaine, the concentration of which depends largely on the vascularity of the region where liposuction is to be carried out. Generally, the maximum dose recommended to most patients is 55mg per kg while for patients undergoing liposuction the dose varies around 35 to 55mg per kg.
However, for more vascular regions like abdomen and breast, an increased dose of 1500 mg per litre can be administered, whereas for not so sensitive areas like thighs the dose is lessened to 500 mg per litre of normal saline. This runs out any risk of lignocaine intoxication enabling infusion of large quantity of wetting solution.
Apart from lignocaine, two other anesthetics that can be used in tumescent solutions are Prilocaine and Articaine. Sodium bicarbonate solution is used as a buffer to decrease the burning sensation that might occur when tumescent solution is injected. It also enables rapid entry of the tumescent solution in the nerve by increasing its pH level. Sometimes steroids are also added to the solution owing to the beneficial effect of their anti-inflammatory property as well as stabilizing characteristic.
