Safety Considerations and Fluid Resuscitation in Liposuction: An Analysis of 53 Consecutive Patients

Abstract

There is no agreement as to appropriate fluid resuscitation in patients undergoing liposuction. This has assumed greater significance, as surgeons have undertaken larger volume aspirations (> or = 4 liters) and the potential complications of hypovolemia and fluid overload have materialized. This prospective study of 53 consecutive healthy patients undergoing liposuction using a superwet technique served to develop general guidelines for safe perioperative fluid management, especially in regard to large-volume aspirations. In this context, "aspirate" is defined as the total fat and fluid that is removed during liposuction. All patients were monitored using standard noninvasive hemodynamic monitoring. Thirty-six patients were monitored perioperatively with Foley catheters. The 53 patients underwent liposuction alone. We did not include patients who underwent concurrent aesthetic surgical procedures because our intention was to establish fluid administration guidelines for the liposuction patient. There were no significant complications in our series. The intraoperative fluid ratio, defined as (intravenous fluid + infiltrate)/aspirate, was 2.1 for the small-volume group and 1.4 for the large-volume group. These values were significantly different (p < .001, t test). Average urine output in the operating room and recovery room and on the floor was satisfactory (> 0.5 to 1 cc/kg/hr) and did not relate to volume aspirated (p = 0.21, 0.91, and 0.6, respectively, t test). Four patients who underwent "large-volume" aspirations (> or = 4 liters) had transient hypotension, which was immediately responsive to crystalloid fluid boluses in the first postoperative hours. All other patients required only maintenance intravenous crystalloid postoperatively until oral intake had been resumed. There were no statistically significant differences in postoperative fluid administration between the small- and large-volume groups. Ninety-three percent of patients were discharged within 24 hours of surgery. Our suggested guidelines for fluid resuscitation based on this retrospective study are as follows: (1) small volume (< 4 liters aspirated): maintenance fluid + subcutaneous wetting solution; (2) large volume (> or = 4 liters aspirated): maintenance fluid + subcutaneous wetting solution + 0.25 cc of intravenous crystalloid per cc of aspirate removed after 4 liters. This formula has since been used in the care of 94 patients who have undergone liposuction exclusively. All patients have had unremarkable hospital courses. These guidelines do not replace sound clinical judgment. Good communication between the surgeon and anesthesiologist is critical to optimal patient care and safety.

Liposuction: Where are We and Where are We Going?

“…Fluid aspirations should be limited to 5 L per session to avoid the excessive third spacing that could jeopardized the ability to compensate the fluid shifts on the average patient. Other rules are to limit the aspirate to less than 5% of the body weight and treat less than 30% of the body surface [28].…”

Ambulatory anesthesia in plastic surgery: opportunities and challenges

“…It is estimated that 50%-70% of the tumescent solution is left behind at the conclusion of the procedure. 62 Of this, 70% of subcutaneous infiltrate is presumed to be intravascular. Importantly, patients with a residual volume of tumescent solution, greater than 70 mg/kg, are at increased risk and need to be monitored for signs of fluid overload and will benefit from extended observation, with possible diuretic administration.…”

Perioperative considerations for patient safety during cosmetic surgery – preventing complications

“…If large volume liposuction is to be performed alone, the surgeon should give serious consideration to removing lidocaine from the tumescence after 4 L to avoid toxicity (31). In addition, the effect of adrenaline can alter cardiac efficiency in patients with significant comorbidities.…”