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Liposuction and Risks of Anesthesia

Liposuction and Risks of Anesthesia – Introduction

A liposuction procedure is a plastic surgery in which excess fat is removed from the body using a narrow tube (cannula) attached to a pump. To insert the tube into the target area, the patient needs to be given anesthesia to relieve the resulting pain. Anesthesia is given locally as the liposuction fluid, also called wetting solution. The solution is a mix of salt water, anesthetic, and epinephrine. Epinephrine is a vasoconstrictor (temporarily narrows blood capillaries) that helps reduce the blood loss from the body during the operation. Though anesthesia alleviates the pain by numbing the treatment area, it can also complicate the entire surgical process if not administered properly. Therefore, there exists a complex equation between liposuction and risk of anesthesia. In fact, most liposuction risks are the ones associated with anesthesia.

Types of Liposuction Anesthesia:

  • General: Also called systemic anesthesia, is given as an intravenous (IV) or inhaled. It makes the patient unconscious.
  • Local: Injected to the target area directly, in local anesthesia, the patient is conscious and aware of the surgery, but does not feel the pain.
  • Regional: Meant for numbing the body below the waist, it is given in the spine as epidural anesthesia.

General and local anesthesia are most common. According to a study conducted by the New England Journal of Medicine, 1998[1], the highest mortality rate has been reported in the case of general anesthesia. The main concerns with the administration of anesthesia are dosage and reaction to the drugs. Of all the methods, tumescent technique using local anesthesia is considered the safest procedure.

General Anesthesia

Before administration, a patient is usually given a combination of drugs to complement and increase the anesthesia’s effectiveness. The idea is to numb the body’s to pain, memory, and awareness. These drugs also help speed recovery. When given general anesthesia, the patient is unconscious and is not aware of anything during the procedure.

  • Modes of Administration: Inhaled as a volatile gas, IV injection, and/or monitored anesthesia care (MAC) – a combination of local & IV anesthesia
  • Risks of Anesthesia in Liposuction:
    • Human Error: The lipo suction death rates are highest in the case of general anesthesia. However, the reasons have rarely been a chemical reaction or any other direct medical influence. Instead, the surgeon’s decision-making and a faulty job have been the culprits. Carelessness, haste, stress, miscommunication or misinterpretation of medical information, error in reading monitoring equipment, poor knowledge about equipment use, and incorrect type or dosage level are some probable human factors triggering the anesthesia risk in liposuction.
    • Excessive Liposuction: It seems easy, convenient and economically sensible to remove a large amount of fat in a single sitting. There is also a temptation to conduct multiple surgeries to cover more than one body area at one session. General anesthesia looks like a useful tool to the patients as well as the surgeons to achieve this. Such rash attempts are immensely risky and may prove disastrous for the patients. Surgical trauma, injury, blood clotting in lungs, excessive fluid infusion, infection, and internal bleeding to death are some of the consequences of surgically stressing the body. Due to numbness, the patient is unable to report any discomfort (including dizziness, pain, and/or breathing issues) associated with these problems.
    • Administration Issues: Incorrect administration, especially excessive fluid or aneshesia dose, may result in brain hemorrhage or cardiac attack. In some cases, the flow of oxygen to the brain may be disrupted, resulting in brain damage. Sometimes, the drug combination in the anesthesia may increase the patient’s heart rate, which can lead to an attack.
    • Internal Injury:There is a high risk of an internal injury remaining unnoticed during the surgery. Due to unconsciousness, the patient is unable to report any discomfort from the injury.
    • Respiratory Issues: General anesthesia used in surgery can result in respiratory problems, including difficulty breathing.

Local Anesthesia

Local anesthesia is injected directly into the target body area. The patient is conscious throughout the procedure, but does not feel the pain. Considered among the safest, lidocaine is the local anesthesia usually used in liposculpture. A large amount of diluted lidocaine is injected into the tissues to numb the treatment area. Although the risk of local anesthesia is quite low, surgical blunders and judgment errors cannot be ruled out.

  • Modes of Administration:Injection
  • Risk of Anesthesia in Liposuction:
    • Administration Issues: The reaction of the patient’s body to the drug is the biggest risk involved. At wrong concentrations, the anesthesia can prove toxic for the body. While its slight increase (6mg/liter of blood) may result in some lidocaine toxicity and excess (over 12mg/liter) in cardiac arrest, inadequate doses may result in discomfort due to the surgical process. The maximum permissible amount of lidocaine in the body is 50mg/kg weight of the person.
    • Drug Interaction & Allergies: The anesthesia can prove risky if it unexpectedly and unfavorably reacts with any other medication present in the body during surgery. In addition, if a patient is allergic to certain chemicals, then it can lead to serious health complications during the surgery. The reactions may decelerate the decomposition and elimination of anesthesia from the body, resulting in lidocaine toxicity.
    • Lidocaine Toxicity:A direct reason for this is the ‘excess’ quantity of lidocaine in the body. However, if lidocaine toxicity occurs despite administering the right quantity, then it may be directly or indirectly due to drug interaction. The chances of toxicity are generally high in heart patients, people weighing less than 70kgs or in thin people. Elderly peoople with weak cardiac or hepatic health are also more vulnerable.  Administering small doses of lidocaine in risky cases is always a safe move.
      • Causes:

  Excess Quantity:

Administration Issue: High dosage injected into the body before liposuction

Excess Surgeries: Frequent liposuction within a short time gap

Tissue Absorption: Abnormally high quantity of lidocaine filters in from the target fat tissues into the blood

  Prolonged Presence in the Body: This mainly deals with the liver’s impaired drug metabolism amounting to lidocaine’s extended stay in the body, resulting in toxicity.

Drug Interaction: Lidocaine may react with the drugs the patient might have taken before or immediately after the surgery

Delayed Elimination: Slow exit of lidocaine from the body after the operation

Consequences:

  Mild Toxicity:

      • Unclear vision – blurred or double
      • Anxiety
      • Confusion
      • Lightheadedness
      • Memory loss
      • Ataxia (loss of co-ordination)
      • Unsteady movement
      • Hyperventilation

Serious Toxicity:

        •  Cardiac Arrest

Other Surgical Hazards: The needle may break or may cause an injury during injecting anesthesia into fat tissues. HK-infiltration cannulae are specialized devices with blunt tips for a safe administration of the anesthesia.

 

Tips to Lower the Anesthesia Risks in Liposuction:

  • Surgeon Selection: Choosing a qualified, skilled and board certified surgeon with a record of success must be the primary goal of the patient.
  • Facility Selection: The surgical facility should meet international stringent quality and safety standards. Well-trained nursing staff and high quality equipment are necessary.
  • Anesthetist: An expert must administer the anesthesia. Make sure your surgeon has a qualified, experienced, board certified, reputable anesthetist. The anesthetist decides on the type, concentration, quantity and administration of anesthesia – depending on the liposuction technique and the surgeon’s views. This helps keep the procedure  safe and smooth.
  • Anesthesia Monitoring Device:The anesthetist must know the use of this device when administering the drug. If used well, this equipment is quite helpful in controlling the anesthesia administration related risk.
  • Patient Eligibility:A physically, mentally and emotionally sound person, over the age of 18 years, with approximately a normal BMI is an ideal candidate for liposuction. Patients with a history or present status of cardiac issues, blood flow irregularity, diabetes, blood pressure problems are usually not eligible. Risk of anesthesia increase with the health problems of the patient. Patients must tell their complete medical history, including the drugs taken and any allergies, to their doctors. This helps the surgeon decide if it is safe to go ahead with the surgery, how, when, and the rest of the anesthesia administration details. Epinephrine increases the heart rate and so does caffeine. Therefore, patients must avoid any caffeine intake at least some time before the surgery. Good doctors provide a list of before / after liposuction precautions the patients must adhere to.
  • Medication: The surgeon must be knowledgeable about drug-drug reactions. The reaction of pre-medication with anesthesia can prove risky for the patient. You must inform the surgeon about any medications taken in the weeks before the surgery. If required, the doctor may delay the surgery or may even cancel it.
  • Safest Technique: Tumescent liposuction under local anesthesia is considered the safest and the most efficient technique. The procedure promises desirable results with very little pain and nominal blood loss.
  • Excessive Liposuction: Multiple surgeries and excessive liposuction in a single sitting just for convenience must be strictly avoided. It is the surgeon’s duty to keep a check on the amount of fat retrieved, regardless of the patient’s demand for more. Before the surgery, do discuss with your surgeon about the amount of fat that can be safely removed from your body.
  • Unrelated Surgeries Simultaneously: Drilling the whole body in one surgical session for convenience can prove potentially threatening to survival. Any surgery is traumatic for a body. Undergoing more than one operation simultaneously will be quite harmful for the body. The use of an increased amount of anesthesia can trigger the complications

References

1 Deaths Related to Liposuction – The New England Journal of Medicine www.nejm.org/doi/full/10.1056/NEJM19990513340190