LIPOSUCTION​

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Liposuction is a type of cosmetic surgery that breaks up and removes fat from the body. It is typically used on areas of the body that haven't responded to diet and exercise, such as the:

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• Abdomen

• Thighs

• Buttocks

• Upper arms

• Back

• Hips

• Chest area

• Calves and ankles

• Chin and neck

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This procedure is typically performed under general, regional, or local anesthesia. The surgeon makes a small incision in the skin, and then inserts a thin tube called a cannula into the fat layer beneath the skin. The cannula is attached to a vacuum that suctions out the fat cells.

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Liposuction is not a treatment for obesity or a substitute for proper diet and exercise. It's also not an effective treatment for cellulite. Rather, it's a way to remove a small amount of excess fat that doesn't go away with traditional weight loss methods.

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                                                               Anesthetic Implications for Liposuction

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Anesthesia type: General anesthesia, IV sedation with local anesthetic

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Airway: ETT or LMA

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Preoperative:

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• Careful body positioning 

• Large-volume (> 5000 mL) resection may require overnight medical observation and monitoring

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Intraoperative:

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• The use of epinephrine-containing wetting solutions injected in the subcutaneous tissue prior to aspiration of fat reduces perioperative blood loss

• Limit the amount of peripheral IV fluid administered because the patient is being instilled with large amounts of the wetting solution

• The wetting solution must be warmed to prevent hypothermia

• Tumescent (wetting) solution injected into the subcutaneous tissue is absorbed over 48 hours

• Diuretics may need to be given

• Watch for fluid shifts and pulmonary edema

• When epinephrine is given, anticipate an increase in the patient’s blood pressure

• Mild controlled hypotension may be requested to facilitate hemostasis

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Postoperative:

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• Smooth emergence

• Avoid coughing, bucking, or nausea and vomiting

• Pain management

• PONV prophylaxis

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Complications:

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• Infection

• Scarring

• Numbness

• Changes in skin color

• Fat emboli

• Fluid overload

• Local anesthetic toxicity

• Pulmonary embolism

• Pulmonary edema

• Pneumothorax

• Damage to internal organs

• Hypothermia

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Sources:

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Longnecker, D. E., Brown, D. L., Newman, M. F., & Zapol, W. M. (2012). Anesthesiology, 2nd ed.

 

Macksey, L. F. (2011). Surgical procedures and anesthetic implications: A handbook for nurse anesthesia practice. 

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Jaffe, R. A. (2020). Anesthesiologist's Manual of Surgical Procedures (6th ed.). 

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Singh-Radcliff, N. (2013). 5-Minute Anesthesia Consult.

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