title: Fluid resuscitation in liposuction: a prospective analysis of infiltrate-to-total aspirate ratios lower than used for the superwet technique.
abstract: BACKGROUND
  Fluid management during liposuction appears to as much an art as it is a science. Because of different infiltration practices such as wet, superwet, and tumescent techniques, different fluid management guidelines are required. This has assumed greater significance as surgeons have undertaken aspirations with larger volumes (>/=4 l) and the potential complications of hypovolemia and fluid overload have materialized.
  
  
  METHODS
  In this prospective study, 580 consecutive patients underwent liposuction using an average infiltrate-to-total aspirate ratio of 0.38. For all the patients, noninvasive hemodynamic parameters were assessed to evaluate a clinically based guideline for fluid management in liposuction.
  
  
  RESULTS
  The average infiltrate-to-total aspirate ratio was 0.38 +/- 0.18 (range, 0.24-0.8). Total urine output was 1.63 ml/kg per hour (range, 1.06-3.4 ml/kg/h). The average postoperative heart rate was 92.16 beats/min, and the average postoperative mean blood pressure readings were 70.41 mmHg. The intraoperative fluid ratio, defined as the ratio of intraoperative intravenous fluid plus subcutaneous infiltrate to total aspirate, ranged from 0.98 to 2.1 (average, 1.25). The average percentage of body weight aspirated was 5.2% (range, 1.76-7.02%)
  
  
  CONCLUSIONS
  This article presents a safe fluid management guideline based on experimental data from 580 patients who underwent liposuction using average infiltration-to-aspirate rates of 0.38. However, the calculated volumes from all the formulas should be viewed as educated guesses of the appropriate fluid load, and clinical judgment is essential.
authors.affiliation: Department of Plastic Surgery, Clinica Basile Medical Center, Avenue Independencia 1530, Ribeirão Preto, 14025-230, Brazil. fibasile@gmail.com
authors.forename: Antonio R
authors.initials: AR
authors.lastname: Basile
authors.forename: Flavio
authors.initials: F
authors.lastname: Fernandes
authors.forename: Vinicius Volpe
authors.initials: VV
authors.lastname: Basile
authors.forename: Filipe V
authors.initials: FV
authors.lastname: Basile
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000767:Anesthesia, Epidural; D001794:Blood Pressure / Q000502:physiology; D001810:Blood Volume / Q000502:physiology*; D015992:Body Mass Index; D005260:Female; D006339:Heart Rate / Q000502:physiology; D006801:Humans; D015187:Lipectomy / Q000379:methods* / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D008991:Monitoring, Physiologic / Q000379:methods; D011182:Postoperative Care; D011446:Prospective Studies; D014556:Urine / Q000502:physiology; D014882:Water-Electrolyte Balance / Q000502:physiology*