Tumescent

yoga crna · Nov 21, 2005

I am not convinced that a formula would work with tumescent local anesthesia for liposuction. The reason is that it is difficult to determine how much of the tumescent fluid is suctioned out with the fat and how much is absorbed into the circulation. I know you were asking about blood loss, but if you look at the history of tumescent local, you will find that it is a technique developed by a dermatologist, Dr. Kline that would eliminate the need for an anesthetist for these cases. A side effect was the fact that the tumescent fluid caused vasoconstriction (probably both from epinephrine and pressure), resulting in less (minimal) blood loss.

I give anesthesia for many tumescent liposuction procedures and rely on my observation skills to manage fluid replacement. Monitor closely the amount suctioned, the color of the aspirate, the vital signs (not urine output) and have the surgeon stop at 5000cc. After surgery, I may give more fluids if the patient gets postural hypotensive.

Liposuction is an interesting procedure. It is the most popular plastic surgery procedure in the world and there have been many deaths from it. Most complications are related to volume of aspirate, inappropriate fluid replacement (they can easily be overhydrated and develop pulmonary edema), perforation of the intestine (85% mortality rate) and fat embolus (rare). A lot of complications are not reported because they are mostly performed as an office procedure.

I will check my files and if I find any formulas for calculating blood loss, I will be happy to post them. However, I stand by my statement that they are clinically irrelevant.

Yoga