Severe fat embolism in perioperative abdominal liposuction and fat grafting.
OBJECTIVE
Fat embolism syndrome 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 fat embolism syndrome 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 45min 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=18mEqL(-1), and lactate=6.0mmolL(-1). 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
Fat embolism syndrome 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.
Centro de Ensino e Treinamento do Hospital Madre Teresa, Belo Horizonte, MG, Brazil; Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, MG, Brazil; Associação de Medicina Intensiva Brasileira (AMIB), São Paulo, SP, Brazil. Electronic address: digoanest@hotmail.com.
Rodrigo
R
de Lima E Souza
Centro de Ensino e Treinamento do Hospital Madre Teresa, Belo Horizonte, MG, Brazil.
Bruno Tavares
BT
Apgaua
Centro de Ensino e Treinamento do Hospital Madre Teresa, Belo Horizonte, MG, Brazil.
João Daniel
JD
Milhomens
Centro de Ensino e Treinamento do Hospital Madre Teresa, Belo Horizonte, MG, Brazil.
Francisco Tadeu Motta
FT
Albuquerque
Centro de Ensino e Treinamento do Hospital Madre Teresa, Belo Horizonte, MG, Brazil.
Luiz Antônio
LA
Carneiro
Centro de Ensino e Treinamento do Hospital Madre Teresa, Belo Horizonte, MG, Brazil.
Márcio Henrique
MH
Mendes
Centro de Ensino e Treinamento do Hospital Madre Teresa, Belo Horizonte, MG, Brazil.
Tiago Carvalho
TC
Garcia
Centro de Ensino e Treinamento do Hospital Madre Teresa, Belo Horizonte, MG, Brazil.
Clerisson
C
Paiva
Centro de Ensino e Treinamento do Hospital Madre Teresa, Belo Horizonte, MG, Brazil.
Felipe
F
Ladeia
Centro de Ensino e Treinamento do Hospital Madre Teresa, Belo Horizonte, MG, Brazil.
Deiler Célio
DC
Jeunon
D000005:Abdomen / Q000601:surgery*; D000273:Adipose Tissue / Q000601:surgery*; D000328:Adult; D000768:Anesthesia, General; D001926:Brain Death / Q000000981:diagnostic imaging / Q000503:physiopathology; D002545:Brain Ischemia / Q000150:complications* / Q000000981:diagnostic imaging / Q000503:physiopathology; D017548:Echocardiography, Transesophageal; D004620:Embolism, Fat / Q000150:complications* / Q000000981:diagnostic imaging; D017809:Fatal Outcome; D005260:Female; D054092:Foramen Ovale, Patent / Q000150:complications / Q000000981:diagnostic imaging / Q000503:physiopathology; D006801:Humans; D007431:Intraoperative Complications / Q000000981:diagnostic imaging / Q000503:physiopathology; D015187:Lipectomy / Q000009:adverse effects*; D020768:Middle Cerebral Artery / Q000000981:diagnostic imaging / Q000503:physiopathology; D059035:Perioperative Period; D012121:Respiration, Artificial; D012720:Severity of Illness Index; D013577:Syndrome; D014057:Tomography, X-Ray Computed
Embolia gordurosa; Fat embolism; Intraoperative; Lipoaspiração; Liposuction; Peroperatório