SAFETY CONSIDERATIONS AND FLUID RESUSCITATION IN LIPOSUCTION - AN ANALYSIS OF 53 CONSECUTIVE PATIENTS

There is no agreement as to appropriate fluid resuscitation in patient s undergoing liposuction. This has assumed greater significance, as su rgeons have undertaken larger volume aspirations (greater than or equa l to 4 liters) and the potential complications of hypovolemia and flui d overload have materialized. This prospective study of 53 consecutive healthy patients undergoing liposuction using a superwet technique se rved to develop general guidelines for safe perioperative fluid manage ment, especially in regard to large-volume aspirations. In this contex t, ''aspirate'' is defined as the total fat and fluid that is removed during liposuction. All patients were monitored using standard noninva sive hemodynamic monitoring. Thirty-six patients were monitored periop eratively with Foley catheters. The 53 patients underwent liposuction alone. We did not include patients who underwent concurrent aesthetic surgical procedures because our intention was to establish fluid admin istration guidelines for the liposuction patient. There were no signif icant complications in our series. The intraoperative fluid ratio, def ined as (intravenous fluid + infiltrate)/aspirate, was 2.1 for the sma ll-volume group and 1.4 for the large-volume group. These values were significantly different (p < .001, t test). Average urine output in th e operating room and recovery room and on the floor was satisfactory ( > 0.5 to 1 cc/kg/hr) and did not relate to volume aspirated (p = 0.21, 0.91, and 0.6, respectively, t test). Four patients who underwent ''l arge-volume'' aspirations (greater than or equal to 4 liters) had tran sient hypotension, which was immediately responsive to crystalloid flu id boluses in the first postoperative hours. All other patients requir ed only maintenance intravenous crystalloid postoperatively until oral intake had been resumed. There were no statistically significant diff erences in postoperative fluid administration between the small- and l arge-volume groups. Ninety-three percent of patients were discharged w ithin 24 hours of surgery. Our suggested guidelines for fluid resuscit ation based on this retrospective study are as follows: (1) small volu me (< 4 liters aspirated): maintenance fluid + subcutaneous wetting so lution; (2) large volume (greater than or equal to 4 liters aspirated) : maintenance fluid + subcutaneous wetting solution + 0.25 cc of intra venous crystalloid per cc of aspirate removed after 4 liters. This for mula has since been used in the care of 94 patients who have undergone liposuction exclusively. All patients have had unremarkable hospital courses. These guidelines do not replace sound clinical judgment. Good communication between the surgeon and anesthesiologist is critical to optimal patient care and safety.