Deaths related to liposuction

Background The technique of tumescent liposuction involves the subcutaneous infusion of a solution containing lidocaine, followed by the aspiration of fat through microcannulas, Although the recommended doses of lidocaine are as high as 55 mg per kilogram of body weight, few safety data are availabl e. Since reporting of adverse events associated with tumescent liposuction is not mandatory, the incidence of complications and deaths is unknown, Methods We identified 5 deaths after tumescent liposuction among 48,527 dea ths referred to the Office of Chief Medical Examiner of the City of New Yor k between 1993 and 1998. The patients' records and postmortem examination r esults were reviewed to identify common contributory factors: Results The five patients had received lidocaine in doses ranging from 10 t o 40 mg per kilogram. Other drugs, such as midazolam, were also administere d. Three patients died as a result of precipitous intraoperative hypotensio n and bradycardia with no definitively identified cause. Postmortem blood l idocaine concentrations in two of the patients were 5.2 and 2 mg per liter. One patient died of fluid overload, and one died of deep venous thrombosis of calf veins with pulmonary thromboembolism after tumescent liposuction o f the legs. Conclusions Tumescent liposuction can be fatal, perhaps in part because of lidocaine toxicity or lidocaine-related drug interactions. (N Engl J Med 19 99; 340:1471-5.) (C) 1999, Massachusetts Medical Society.