Hemodynamic physiology and thermoregulation in liposuction.
Little is known about the physiology of large-volume liposuction. Patients are exposed to prolonged procedures, general anesthesia, fluid shifts, and infusion of high doses of epinephrine and lidocaine. Consequently, the authors examined the thermoregulatory and cardiovascular responses to liposuction by assessing multiple physiologic factors. The aims of their study were to serially determine hemodynamic parameters perioperatively, to quantify perioperative and postoperative plasma epinephrine levels, and to chronologically document fluctuations in core body temperature. Five female volunteers with American Society of Anesthesiologists' physical status I and II underwent moderate- to large-volume liposuction. Heart rate, blood pressure, mean pulmonary arterial pressure, cardiac index, and central venous pressure were monitored. Serum epinephrine levels and core body temperature were assessed perioperatively. The hemodynamic responses to liposuction were characterized by an increase in cardiac index (57 percent), heart rate (47 percent), and mean pulmonary arterial pressure (44 percent) (p < 0.05). Central venous pressure was not significantly altered. Maximum epinephrine levels were observed 5 to 6 hours after induction. Significant correlations between cardiac index and epinephrine concentrations were shown intraoperatively (r = 0.75). All patients developed intraoperative low body temperatures (mean 35.5 degrees C). An overall enhanced cardiac function was observed in patients subsequent to large-volume liposuction. The etiology of the altered cardiac parameters was multifactorial but may have been attributable in part to the administration of epinephrine, which counters the effects of general anesthesia and operative hypothermia. Additional explanations for raised cardiac output may be hemodilution or emergence from general anesthesia. Elevated mean pulmonary arterial pressure may be a result of subclinical fat embolism demonstrated in previous porcine studies, although fat was not observed in urine. The unchanged central venous pressure levels indicate that young healthy patients with compliant right ventricles can accommodate the fluid loads of large-volume liposuction. Overall hemodynamic parameters remained within safe limits. Within these surgical parameters, patients should be clinically screened for cardiovascular and blood pressure disorders before liposuction is undertaken, and preventative measures should be taken to limit intraoperative hypothermia.
Department of Plastic Surgery, Nancy Lee and Perry R. Bass Advanced Plastic Surgery and Wound Healing Laboratory, University of Texas Southwestern Medical Center, Dallas, 75390-9132, USA. jeffrey.kenkel@utsouthwestern.edu
Jeffrey M
JM
Kenkel
Avron H
AH
Lipschitz
Maureen
M
Luby
Ian
I
Kallmeyer
Evan
E
Sorokin
Eric
E
Appelt
Rod J
RJ
Rohrich
Spencer A
SA
Brown
D000328:Adult; D000768:Anesthesia, General; D001833:Body Temperature Regulation / Q000187:drug effects / Q000502:physiology*; D002302:Cardiac Output / Q000187:drug effects / Q000502:physiology; D002319:Cardiovascular System / Q000503:physiopathology; D004620:Embolism, Fat / Q000503:physiopathology; D004837:Epinephrine / Q000008:administration & dosage / Q000009:adverse effects / Q000493:pharmacokinetics; D005260:Female; D006438:Hemodilution; D006439:Hemodynamics / Q000187:drug effects / Q000502:physiology*; D006801:Humans; D007035:Hypothermia / Q000139:chemically induced / Q000503:physiopathology; D007431:Intraoperative Complications / Q000503:physiopathology; D008012:Lidocaine / Q000008:administration & dosage / Q000009:adverse effects / Q000493:pharmacokinetics; D015187:Lipectomy; D011183:Postoperative Complications / Q000503:physiopathology; D011655:Pulmonary Embolism / Q000503:physiopathology; D011669:Pulmonary Wedge Pressure / Q000187:drug effects / Q000502:physiology
D008012:Lidocaine; D004837:Epinephrine