title: [Severe fat embolism in perioperative abdominal liposuction and fat grafting].
abstract: OBJECTIVE
  Fat embolism syndrome (FES) may occur in patients suffering from multiple trauma (long bone fractures) or plastic surgery (liposuction), compromising the circulatory, respiratory and/or central nervous systems. This report shows the evolution of severe FES after liposuction and fat grafting.
  
  
  METHODS
  SSS, 42 years old, ASA 1, no risk factors for thrombosis, candidate for abdominal liposuction and breast implant prosthesis. Subjected to balanced general anesthesia with basic monitoring and controlled ventilation. After 45minutes of procedure, there was a sudden and gradual decrease of capnometry, severe hypoxemia and hypotension. The patient was immediately monitored for MAP and central catheter, treated with vasopressors, inotropes, and crystalloid infusion, stabilizing her condition. Arterial blood sample showed pH = 7.21; PCO2 = 51mmHg; PO2 = 52mmHg; BE = -8; HCO3 = 18 mEq/L, and lactate = 6.0 mmol/L. Transthoracic echocardiogram showed PASP = 55mmHg, hypocontractile VD and LVEF = 60%. Diagnosis of pulmonary embolism. After 24h of intensive treatment, the patient developed anisocoria and coma (glasgow coma scale = 3). A brain CT was performed which showed severe cerebral hemispheric ischemia with signs of fat emboli in right middle cerebral artery; transesophageal echocardiography showed a patent foramen ovale. Finally, after 72h of evolution, the patient progressed to brain death.
  
  
  CONCLUSIONS
  FES usually occurs in young people. Treatment is based mainly on the infusion of fluids and vasoactive drugs, mechanical ventilation, and triggering factor correction (early fixation of fractures or suspension of liposuction). The multiorgânico involvement indicates a worse prognosis.
authors.affiliation: Centro de Ensino e Treinamento do Hospital Madre Teresa, Belo Horizonte, MG, Brasil; Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, MG, Brasil; Associação de Medicina Intensiva Brasileira (AMIB), São Paulo, SP, Brasil. Electronic address: digoanest@hotmail.com.
authors.forename: Rodrigo
authors.initials: R
authors.lastname: de Lima E Souza
authors.affiliation: Centro de Ensino e Treinamento do Hospital Madre Teresa, Belo Horizonte, MG, Brasil.
authors.forename: Bruno Tavares
authors.initials: BT
authors.lastname: Apgaua
authors.affiliation: Centro de Ensino e Treinamento do Hospital Madre Teresa, Belo Horizonte, MG, Brasil.
authors.forename: João Daniel
authors.initials: JD
authors.lastname: Milhomens
authors.affiliation: Centro de Ensino e Treinamento do Hospital Madre Teresa, Belo Horizonte, MG, Brasil.
authors.forename: Francisco Tadeu Motta
authors.initials: FT
authors.lastname: Albuquerque
authors.affiliation: Centro de Ensino e Treinamento do Hospital Madre Teresa, Belo Horizonte, MG, Brasil.
authors.forename: Luiz Antônio
authors.initials: LA
authors.lastname: Carneiro
authors.affiliation: Centro de Ensino e Treinamento do Hospital Madre Teresa, Belo Horizonte, MG, Brasil.
authors.forename: Márcio Henrique
authors.initials: MH
authors.lastname: Mendes
authors.affiliation: Centro de Ensino e Treinamento do Hospital Madre Teresa, Belo Horizonte, MG, Brasil.
authors.forename: Tiago Carvalho
authors.initials: TC
authors.lastname: Garcia
authors.affiliation: Centro de Ensino e Treinamento do Hospital Madre Teresa, Belo Horizonte, MG, Brasil.
authors.forename: Clerisson
authors.initials: C
authors.lastname: Paiva
authors.affiliation: Centro de Ensino e Treinamento do Hospital Madre Teresa, Belo Horizonte, MG, Brasil.
authors.forename: Felipe
authors.initials: F
authors.lastname: Ladeia
authors.affiliation: Centro de Ensino e Treinamento do Hospital Madre Teresa, Belo Horizonte, MG, Brasil.
authors.forename: Deiler Célio
authors.initials: DC
authors.lastname: Jeunon
keywords: Embolia gordurosa; Fat embolism; Intraoperative; Lipoaspiração; Liposuction; Peroperatório