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Aesthetic Plastic Surgery

27-03-2024 | Liposuction | Original Article

Enhancing Safety in Tumescent Liposuction: Managing Sedation-Related Respiratory Issues and Serious Complications Under Deep Sedation with the Propofol–Ketamine Protocol

Authors: Eun Ju Kim, Hyunju Kim, Younchan Park

Published in: Aesthetic Plastic Surgery

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Abstract

Background

Over the past 4 years, aesthetic surgery, notably liposuction, has substantially increased. Tumescent liposuction, a popular technique, has two variants—true tumescent liposuction (TTL) and semi-tumescent liposuction. While TTL reduces risks, it has limitations. There is no literature reported on semi-tumescent liposuction under deep sedation using the propofol–ketamine protocol, which is proposed as a potentially safe alternative.

Methods

The retrospective analysis covered 8 years and included 3094 patients performed for tumescent liposuction under deep sedation, utilizing the propofol–ketamine protocol. The evaluation of patient safety involved an examination of potential adverse events with a specific focus on respiratory issues related to sedation, including instances of mask ventilation.

Results

Among the 3094 cases, no fatalities were recorded. Noteworthy events included 43 mask ventilation instances, primarily occurring in the initial 10 min. Twelve cases experienced surgery cancellation due to various factors, including respiratory issues. Three patients were transferred to upper-level hospitals, while another three required blood transfusions. Vigilant management prevented significant complications, and other adverse events like venous thromboembolism (VTE), fat embolism, severe lidocaine toxicity, and so on were not observed.

Conclusions

The analysis of 3094 tumescent liposuction cases highlighted the overall safety profile of the propofol–ketamine protocol under deep sedation. The scarcity of severe complications underscores its viability. The study emphasizes the significance of thorough preoperative assessments, careful patient selection, and awareness of potential complications. Prompt interventions, particularly in addressing sedation-related respiratory issues, further contribute to positive outcomes for patients.

Level of Evidence IV

This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.​springer.​com/​00266.
Literature
1.
2.
Klein JA (1987) The tumescent technique for lipo-suction surgery. Am J Cosmet Surg 4:263–267CrossRef
3.
Hsia HC (2016) On beyond lidocaine: reconsidering local anesthetics in tumescent liposuction—a critical review. Ann Plast Surg 77(1):S66–S69PubMedCrossRef
4.
Coldiron BM, Healy C, Bene NI (2008) Office surgery incidents: what seven years of Florida data show us. Dermatol Surg 34(3):285–291PubMed
5.
Halk AB, Habbema L, Genders RE, Hanke CW (2019) Safety studies in the field of liposuction: a systematic review. Dermatol Surg 45(2):171–182PubMedCrossRef
6.
Weinberg G (2016) Local anesthetic systemic toxicity and liposuction: looking back, looking forward. Anesth Analg 122(5):1250–1252PubMedCrossRef
7.
8.
Wang G, Cao W-G, Li S-L, Liu L-N, Jiang Z-H (2015) Safe extensive tumescent liposuction with segmental infiltration of lower concentration lidocaine under monitored anesthesia care. Ann Plast Surg 74(1):6–11PubMedCrossRef
9.
Scarborough DA, Herron JB, Khan A, Bisaccia E (2003) Experience with more than 5000 cases in which monitored anesthesia care was used for liposuction surgery. Aesthetic Plast Surg 27(6):474–480PubMedCrossRef
10.
Yoho R, Mullen K (2003) Modified propofol–ketamine cosmetic surgery: anesthesia technique for surgeon-administered anesthesia with particular reference to liposuction. Am J Cosmet Surg 20(3):149–154CrossRef
11.
12.
Friedberg BL (2003) Propofol ketamine anesthesia for cosmetic surgery in the office suite. Int Anesthesiol Clin 41(2):39–50PubMedCrossRef
13.
Hayes JA, Aljuhani T, De Oliveira K, Johnston BC (2021) Safety and efficacy of the combination of propofol and ketamine for procedural sedation/anesthesia in the pediatric population: a systematic review and meta-analysis. Anesth Analg 132(4):979–992PubMedCrossRef
14.
Sabertanha A, Shakhsemampour B, Ekrami M, Allahyari E (2019) Comparison of infusion of propofol and ketamine–propofol mixture (Ketofol) as anesthetic maintenance agents on blood pressure of patients undergoing orthopedic leg surgeries. Anesth Pain Med 9(6):e96998–e96998PubMedPubMedCentral
15.
16.
17.
Holm C, Christensen M, Schulze S, Rosenberg J (1999) Effect of oxygen on tachycardia and arterial oxygen saturation during colonoscopy. Eur J Surg 165(8):755–758PubMedCrossRef
18.
Mohammed BS, Cohen S, Reeds D, Young VL, Klein S (2008) Long-term effects of large-volume liposuction on metabolic risk factors for coronary heart disease. Obesity 6(12):2648–2651CrossRef
19.
Badran S, Doi SA, Hamdi M, Hammouda A, Alharami S, Clark J, Musa OAH, Abou-Samra AB, Habib AM (2023) Metabolic aspects of surgical subcutaneous fat removal: an umbrella review and implications for future research. Biomol Biomed 23(2):235–247PubMedPubMedCentral
20.
Narsete T, Narsete M, Buckspan R, Ersek R (2012) Large-volume liposuction and prevention of type 2 diabetes: a preliminary report. Aesthetic Plast Surg 36(2):438–442PubMedCrossRef
21.
Grazer FM, De Jong RH (2000) Fatal outcomes from liposuction: census survey of cosmetic surgeons. Plast Reconstr Surg 105(1):436–446PubMedCrossRef
22.
Doran FS, Drury M, Sivyer A (1964) A simple way to combat the venous stasis which occurs in the lower limbs during surgical operations. Br J Surg 51:486–492PubMedCrossRef
23.
Bermudez K, Knudson MM, Morabito D, Kessel O (1998) Fasciotomy, chronic venous insufficiency, and the calf muscle pump. Arch Surg 133(12):1356–1361PubMedCrossRef
24.
Latif H, Baez Sosa V, Farid S, Fernandez S, Hazen N, Morozov V, Fitzpatrick KW (2020) Venous thromboembolism in women with uterine fibroids. Blood 136(Supplement 1):28–29CrossRef
25.
Norman NC, Klein PA, Choi NJ, Smith DG, Klein JA (2023) Pulmonary embolism after liposuction totally by tumescent local anesthesia in a patient with large uterine fibroids. Plast Reconstr Surg Glob Open 11(3):e4876PubMedPubMedCentralCrossRef
26.
Wang HD, Zheng JH, Deng CL, Liu QY, Yang SL (2008) Fat embolism syndromes following liposuction. Aesthetic Plast Surg 32(5):731–736PubMedCrossRef
27.
28.
Scarlatescu E, Marchenko SP, Tomescu DR (2021) Lidocaine effects on coagulation assessed by whole blood rotational thromboelastometry. Blood Coagul Fibrinolysis 32(2):115–121PubMedCrossRef
29.
Karnina R, Arif SK, Hatta M, Bukhari A (2021) Molecular mechanisms of lidocaine. Ann Med Surg (Lond) 69:102733PubMed
30.
31.
Lee JT, Sanderson CR, Xuan W, Agar M (2019) Lidocaine for cancer pain in adults: a systematic review and meta-analysis. J Palliat Med 22(3):326–334PubMedCrossRef
32.
Svedman KJ, Coldiron B, Coleman WP 3rd, Cox SE, Jacob C, Lawrence N, Kaminer M, Narins RS (2006) ASDS guidelines of care for tumescent liposuction. Dermatol Surg 32(5):709–716PubMedCrossRef
33.
Klein JA, Kassarjdian N (1997) Lidocaine toxicity with tumescent liposuction: a case report of probable drug interactions. Dermatol Surg 23(12):1169–1174PubMedCrossRef
34.
Shiffman MA (1998) Medications potentially causing lidocaine toxicity. Am J Cosmet Surg 15(3):227–228CrossRef
35.
Cárdenas-Camarena L, Andrés Gerardo LP, Durán H, Bayter-Marin JE (2017) Strategies for reducing fatal complications in liposuction. Plast Reconstr Surg Glob Open 5(10):e1539PubMedPubMedCentralCrossRef
36.
Sergio G-T, Carlos B-V, Cecilia C-M, Marcela C-L (2019) Anesthesia management for large-volume liposuction. In: Víctor MWL (ed) Anesthesia topics for plastic and reconstructive surgery, vol 4. IntechOpen, Rijeka
37.
Rohrich RJ, Leedy JE, Swamy R, Brown SA, Coleman J (2006) Fluid resuscitation in liposuction: a retrospective review of 89 consecutive patients. Plast Reconstr Surg 117(2):431–435PubMedCrossRef
38.
Goodman NW, Black AM, Carter JA (1987) Some ventilatory effects of propofol as sole anaesthetic agent. Br J Anaesth 59(12):1497–1503PubMedCrossRef
39.
40.
Bajwa SJS, Bajwa SK, Kaur J (2010) Comparison of two drug combinations in total intravenous anesthesia: propofol–ketamine and propofol-fentanyl. Saudi J Anaesth 4(2):72–79PubMedPubMedCentralCrossRef
41.
42.
Isono S, Warner DS, Warner MA (2009) Obstructive sleep apnea of obese adults: pathophysiology and perioperative airway management. Anesthesiology 110(4):908–921PubMedCrossRef
43.
Salome CM, King GG, Berend N (2010) Physiology of obesity and effects on lung function. J Appl Physiol 108(1):206–211PubMedCrossRef
44.
Jörres RA, Scholl N, Dressel H, Kauffmann-Guerrero D, Karrasch S, Ochmann U, Kneidinger N, Alter P, Magnussen H, Behr J, Nowak D, Kahnert K (2022) A new approach for the detection of obesity-related airway obstruction in lung-healthy individuals. Respir Med 205:107025PubMedCrossRef
45.
Tagaito Y, Isono S, Nishino T (1998) Upper airway reflexes during a combination of propofol and fentanyl anesthesia. Anesthesiology 88(6):1459–1466PubMedCrossRef
46.
Nishino T (2000) Physiological and pathophysiological implications of upper airway reflexes in humans. Jpn J Physiol 50(1):3–14PubMedCrossRef
47.
48.
Spijkerman S (2017) Laryngospasm in anaesthesia. South Afr J Anaesth Analg 23(2):74–80
49.
50.
51.
Metadata
Title
Enhancing Safety in Tumescent Liposuction: Managing Sedation-Related Respiratory Issues and Serious Complications Under Deep Sedation with the Propofol–Ketamine Protocol
Authors
Eun Ju Kim
Hyunju Kim
Younchan Park
Publication date
27-03-2024
Publisher
Springer US
Published in
Aesthetic Plastic Surgery
Print ISSN: 0364-216X
Electronic ISSN: 1432-5241
DOI
https://doi.org/10.1007/s00266-024-03963-w