title: 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.
authors.affiliation: Department of Plastic and Reconstructive Surgery, University of Texas Southwestern Medical Center, Dallas 75235-9132, USA.
authors.forename: S A
authors.initials: SA
authors.lastname: Trott
authors.forename: S J
authors.initials: SJ
authors.lastname: Beran
authors.forename: R J
authors.initials: RJ
authors.lastname: Rohrich
authors.forename: J M
authors.initials: JM
authors.lastname: Kenkel
authors.forename: W P
authors.initials: WP
authors.lastname: Adams
authors.forename: K W
authors.initials: KW
authors.lastname: Klein
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000700:Analgesics / Q000009:adverse effects; D005260:Female; D006801:Humans; D007022:Hypotension / Q000209:etiology; D008012:Lidocaine / Q000009:adverse effects; D015187:Lipectomy / Q000379:methods*; D008297:Male; D008875:Middle Aged; D008991:Monitoring, Physiologic; D019990:Perioperative Care; D011182:Postoperative Care; D011446:Prospective Studies; D012449:Safety; D014882:Water-Electrolyte Balance
chemical_list: D000700:Analgesics; D008012:Lidocaine