Cardiac Arrest Following Liposuction: A Case Report of Lidocaine Toxicity

Abstract

We report a case of a patient presenting to the emergency department in cardiac arrest following a liposuction procedure, which was performed in a physician office using lidocaine anesthesia. During liposuction of the thighs, using the power-assisted technique, the patient was given a subcutaneous dose of lidocaine equal to 71 mg/kg without any noticeable intraoperative complication. Two hours later, the patient experienced dizziness, a rapid decline in mental status, tonic-clonic seizure, and cardiac arrest. The patient was successfully resuscitated in the emergency department with the return of spontaneous circulation after 22 minutes of continuous advanced cardiovascular life support resuscitation. The patient suffered from subsequent severe hypoxic-ischemic brain injury, and a complicated hospital stay, including brain edema, electrolytes disturbances, and nosocomial infections contributed to her death two months later due to septic shock.

Severe Postoperative Bleeding Following Minor-to-Moderate Abdominal and Flank Liposuction Performed at a Day Surgery Center: A Case Report

“…The potential for imprecisions and bias regarding reported postsurgical complications is within the bounds of possibility, due to the sensitive nature of such accounts. We conclude that this case report, and others which describe adverse effects and complications [ 9 , 20 ], help form a more balanced and whole picture regarding the safety of liposuction. It shows the need for careful patient selection, and the importance of an experienced surgeon, well-functioning surgical team, and adequate follow-up care when performing an office-based procedure.…”

An unusual case of oral surgical management in a patient with isovaleric acidemia and schizophrenia: A case report

“…Patients with IVA can successfully be treated with GA using agents like sevoflurane, nitrous oxide, thiopental, fentanyl, desflurane, nitrous oxide and vecuronium (23). However, reported incidences of development of ventricular tachycardia shortly after bupivacaine and epinephrine injection (25), and cardiac arrest following the use of lidocaine as an RA agent have also been reported (24). Similarly, a report of a patient having a reduced threshold for developing malignant dysrhythmias due to IVA-associated carnitine deficiency has been described (25).…”

“…Notably, the patient and his next of kin also preferred surgery under general anesthesia (GA). However, considering his medical history, the following perioperative management strategies were implemented to minimize the risk factors of complications: i) The surgical team chose regional anesthesia (RA) to avoid IVA crises of disordered metabolism, including glucose disturbances, hyperammonemia, hypocalcemia and non-anion gap metabolic acidosis due to GA-associated prolonged fasting, poor nutrition, electrolyte imbalance and other physiological stresses; ii) 3% mepivacaine, and not bupivacaine or lidocaine, was selected as the preferred drug for RA to reduce the risk of developing local anesthetic systemic toxicity (LAST) based on the report of a patient having a reduced threshold for developing malignant dysrhythmias due to IVA-associated carnitine deficiency (24,25); iii) since IVA can cause bone marrow suppression during crises, postoperative infection was considered a risk factor for IVA crises. Therefore, although bone marrow suppression was not observed in blood biochemistry hematology results, we planned to adequately prevent infection with antibacterial agents before and after surgery (21,22); iv) antibiotics other than pivalate-containing medications were used as IVA raises acylcarnitine levels, and antibiotics containing pivalate already have the possibility of increasing acylcarnitine levels (26); v) tooth extraction was conducted in stages to avoid trismus related to removing all four teeth immediately and seizures of IVA crisis due to poor eating; vi) the patient was managed as an outpatient to reduce psychological stress related to the coexisting pandemic restrictions for preventing coronavirus disease-2019 caused by severe acute respiratory syndrome coronavirus 2; and vii) although investigations revealed normal ECG and echocardiogram findings, the continuation of antipsychotic therapy, olanzapine, was evaluated in consultation with the attending psychiatrist to avoid side effects of drug interactions.…”

Sudden Cardiac Arrest During a Prolonged Liposuction and Lipofilling Procedure: A Case Report

“…It was first performed in 1970s. It is considered as a relatively safe operation with a complication rate of 0.25% and an overall mortality rate of less than 0.002% [ 1 ]. However, with increasing numbers of the performed procedures, more complications have been increasingly reported.…”