| PRS 0408-503 Kenkel
Kenkel JM, Lipschitz AH, Luby M, Kallmeyer I, Sorokin E, Appelt E, Rohrich RJ,
Brown SA.
Hemodynamic physiology and thermoregulation in liposuction.
Plast Reconstr Surg. 2004 Aug;114(2):503-13; discussion 514-5. PMID: 15277823
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
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.
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