Tumescent Liposuction under General Anesthesia

1992 ◽  
Vol 9 (1) ◽  
pp. 49-54 ◽  
Author(s):  
Howard A. Tobin
Keyword(s):  
Blood Loss ◽  
General Anesthesia ◽  
Local Anesthesia ◽  
Autologous Transfusion ◽  
Tumescent Liposuction ◽  
Liposuction Surgery ◽  
Hemostatic Effects

Tumescent liposuction has been recently established as a technique of infiltration of dilute concentrations of lidocaine and adrenalin, which appears to drastically limit the amount of blood loss during liposuction surgery. Previous reports focused on its use under local anesthesia. I have found that it is equally applicable to patients undergoing liposuction surgery under general anesthesia and have also found that the concentration of adrenalin can be reduced from 1: 1,000,000 to 1: 4,000,000 without compromising the hemostatic effects. The technique allows relatively large amounts of fat to be aspirated safely without autologous transfusion.

scholarly journals Tumescent local anesthesia as an alternative to general anesthesia in release of post-burn neck contracture and skin graft harvesting: A comparative study

2021 ◽  
Vol 25 (1) ◽  
Author(s):  
Mukesh Kumar Prasad ◽  
Payal Jain ◽  
Rohit Kumar Varshney ◽  
Aditi Khare ◽  
Gurdeep Singh Jheetay
Keyword(s):  
Postoperative Pain ◽  
Pain Relief ◽  
Blood Loss ◽  
General Anesthesia ◽  
Local Anesthesia ◽  
Skin Graft ◽  
Tumescent Local Anesthesia ◽  
Graft Harvest ◽  
Contracture Release ◽  
Split Skin

Background: Anesthetic management of severe post burn neck contracture is difficult, demanding due to fixed flexion deformity of neck, incomplete oral occlusion and insufficient mouth opening leading to difficulty in intubation. Patients undergoing contracture release, skin graft harvest under general anesthesia (GA) were compared with patients undergoing the same surgery under tumescent local anesthesia (TLA) technique. Methodology: Twenty-one patients with post burn neck contracture undergoing contracture release with split skin grafting under GA were compared with twenty-one patients undergoing the same surgery under TLA. Post-operative pain and satisfaction were assessed using 10 cm VAS (Visual Analogue Scale).  Results: Demographic profile was comparable in both groups. Changes in intra-operative vital parameters remained insignificant. The average volume of tumescent solution used was 254.76 + 49.05ml. Blood loss was significantly decreased, postoperative pain relief was more than sixteen hours in thirteen patients and extended beyond twenty-four hours in six patients in the TLA group. Time for the first rescue analgesia was significantly lesser in the GA group and the average dose of injection tramadol used in the GA group was significantly higher within the first 24 h. Overall satisfaction in the TLA group was significantly higher than in the GA group. Conclusion: TLA can be used as sole technique for release of post burn neck contracture and harvest of split skin grafts with less blood loss and significantly better postoperative pain relief avoiding complications of general anesthesia. Key words: Tumescent local anesthesia; Post burn neck contracture; Skin graft harvest; General anesthesia Citation: Prasad MK, Jain P, Varshney RK, Khare A, Jheetay GS. Tumescent local anesthesia as an alternative to general anesthesia in the release of post-burn neck contracture and skin graft harvesting: A comparative study. Anaesth. Pain intensive care 2021;25(1):34–39. DOI: 10.35975/apic.v25i1.1434 Received: 18 February 2020, Reviewed: 16 March 2020, Accepted: 30 April 2020

scholarly journals Advantages of Tonsillectomy done under Local Anesthesia compared to General Anesthesia in Adults

2013 ◽  
Vol 4 (1) ◽  
pp. 13-18 ◽  
Author(s):  
Sudhir Naik ◽  
Sarika S Naik ◽  
S Ravishankara ◽  
Mohan K Appaji ◽  
MK Goutham ◽  
...  
Keyword(s):  
Blood Loss ◽  
General Anesthesia ◽  
Local Anesthesia ◽  
Case Series ◽  
Limited Resources ◽  
Pain Scores ◽  
Significant Difference ◽  
Duration Of Surgery ◽  
The Mean ◽  
Head Neck

ABSTRACT Background/Objectives Tonsillectomy using local anesthesia (local tonsillectomy) is a safe and effective alternative to general anesthesia in the healthy cooperative teenage or adult patients. Blood loss, morbidity, complications and patient satisfaction were better in some studies with tonsillectomies done under general anesthesia. Design Comparative case series analysis study of two groups of patients who underwent tonsillectomies under local and general anesthesia during the study period of 57 months from March 2007 to December 2011. Materials and methods Overall 1,349 cases of tonsillectomies done for chronic tonsillitis were included under the study. Three hundred and sixty-seven cases operated under general anesthesia and 982 cases operated under local anesthesia were compared. The parameters compared were duration of surgery, blood loss and the mean pain visual analog score. Results Significant difference in duration of surgery, blood loss during surgery and visual analog scale (VAS) pain scores were seen in the two groups with local anesthesia scoring over general anesthesia. Conclusion Tonsillectomy under local anesthesia is a good alternate for the procedure under general anesthesia with limited resources and in cooperative adults. How to cite this article Naik SM, Naik SS, Ravishankara S, Appaji MK, Goutham MK, Devi NP, Mushannavar AS. Advantages of Tonsillectomy done under Local Anesthesia compared to General Anesthesia in Adults. Int J Head Neck Surg 2013;4(1):13-18.

The Tumescent Technique for Lipo-Suction Surgery

1987 ◽  
Vol 4 (4) ◽  
pp. 263-267 ◽  
Author(s):  
Jeffrey A. Klein
Keyword(s):  
Blood Loss ◽  
General Anesthesia ◽  
Local Anesthesia ◽  
Large Volume ◽  
Subcutaneous Fat ◽  
Tumescent Technique ◽  
Intravenous Line ◽  
Anesthetic Solution

The tumescent technique of lipo-suction is a modification of the wet technique. A large volume of very dilute epinephrine is infiltrated into a targeted fat compartment prior to lipo-suction, producing a swelling and firmness. This tumescence of fat permits an increased accuracy in lipo-suction and minimizes postsurgical irregularities or rippling of the skin. Epinephrine-induced vasoconstriction minimizes blood loss, bruising, and postoperative soreness. Safe, rapid infiltration of large volumes of solution is achieved using a closed sterile system featuring a newly designed blunt-tipped, 30-cm-long, 4.7-mm-diameter needle having a hollow handle that accommodates a 60-cc syringe. Attached to a liter bottle of anesthetic solution by an intravenous line, the needle is inserted via the same incision and deposits the solution along the same path as that intended for the lipo-suction cannula. Thus, the solution is infiltrated exactly where it is needed for hemostasis or local anesthesia. Used in conjunction with general anesthesia, the tumescent technique saves time in achieving maximal vasoconstriction of the targeted fat compartment. If dilute lidocaine (0.1%) is added to the solution, the technique permits lipo-suction of more than 2 liters of fat totally by local anesthesia. Twenty-six patients, having received a mean lidocaine dose of 1250 mg (18.4 mg/kg or 8.5 mg/kg/hr) infiltrated into subcutaneous fat, had a mean serum lidocaine level of less than 0.36 μg/ml 1 hour after completion of the infiltration.

Anesthesia in Liposuction Surgery

1997 ◽  
Vol 14 (1) ◽  
pp. 63-70 ◽  
Author(s):  
Melvin A. Shiffman
Keyword(s):  
Blood Loss ◽  
General Anesthesia ◽  
Recovery Time ◽  
Intravenous Sedation ◽  
Intravenous Anesthesia ◽  
Tumescent Technique ◽  
Liposuction Surgery

Three types of anesthesia, local, general, or intravenous sedation, are available for patients undergoing liposuction. The tumescent technique surpassed all other methods of suction-assisted lipectomy in reduction of blood loss and may be used with local, general, or intravenous anesthesia. The difficulties associated with each type of anesthesia include lenghthiness of the procedure under local, the longer recovery time with general anesthesia, and the risks of intravenous medications and general anesthesia. After the difficulties are discussed with the patient, the patient makes the choice of the type of anesthesia to be administered. The author prefers the use of general anesthesia because it allows the tumescent technique to be performed quickly and efficiently.

Comparison of Functional Endoscopic Sinus Surgery under Local and General Anesthesia

1993 ◽  
Vol 102 (4) ◽  
pp. 289-293 ◽  
Author(s):  
Paul D. Gittelman ◽  
Joseph B. Jacobs ◽  
Jane Skorina
Keyword(s):  
Blood Loss ◽  
General Anesthesia ◽  
Local Anesthesia ◽  
Endoscopic Sinus Surgery ◽  
Functional Endoscopic Sinus Surgery ◽  
Sinus Surgery ◽  
Intravenous Sedation ◽  
New York University ◽  
Major Complications ◽  
Estimated Blood Loss

We present a retrospective comparison of intravenous sedation and general anesthesia techniques employed at New York University—Bellevue Medical Center for functional endoscopic sinus surgery. Some authors have stressed the use of local anesthesia with intravenous sedation in order to avoid complications and reduce blood loss. We have reviewed 232 patients who underwent 401 consecutive ethmoidectomies and maxillary antrostomies. Local anesthesia, employed in 64% of patients, carried an estimated blood loss of 23 mL per side. General anesthesia was associated with an average blood loss of 58 mL per side. The rate of operative complications for local anesthesia was 8.7% per patient, with a 1.6% rate of major complications per side. General anesthesia carried an overall complication rate of 2.4% per patient, with no major complications. General anesthesia is a relatively safe and viable option for endoscopic sinus surgery that in selected cases may be preferable to local anesthesia.

Safety of Tumescent Liposuction Compared with Liposuction in Systemic Sedation or General Anesthesia—A Review of the Literature

2007 ◽  
Vol 24 (3) ◽  
pp. 139-142
Author(s):  
Roland Boni
Keyword(s):  
General Anesthesia ◽  
Pain Control ◽  
Hospital Setting ◽  
Intravenous Sedation ◽  
Review Of The Literature ◽  
Cosmetic Procedure ◽  
Fat Deposits ◽  
Tumescent Solution ◽  
Tumescent Liposuction ◽  
Liposuction Surgery

Introduction: Liposuction surgery is increasing in frequency and is currently the most commonly performed cosmetic procedure. In tumescent liposuction, the unwanted fat deposits are injected with tumescence fluid containing saline, epinephrine, and lidocaine, the latter used as the only source of pain control. Tumescent liposuction has to be clearly distinguished from liposuction, where tumescent solution is locally applied, but pain is controlled with systemic sedation (oral, intramuscular, or intravenous sedation, rarely spinal sedation), or general anesthesia. Methods: In this study, the different anesthesiologic techniques currently used for liposuction are compared with regard to safety. Reported fatalities attributed to liposuction were reviewed, and it was determined, whether tumescent liposuction was performed or whether liposuction was assisted with systemic sedation or general anesthesia. Results: To date, no fatalities have been reported in tumescent liposuction and only minor complications have been described. The safety of tumescent liposuction could be demonstrated in 396,457 reported cases (including own data) performed in either an office-based or a hospital setting. Fatalities (n = 110), however, have been reported when pain was controlled by systemic sedation or when general anesthesia was applied. A mortality rate of 2.6–19.1 per 100,000 cases was calculated. Conclusion: Based on these findings, it is concluded that tumescent liposuction is currently the safest anesthesiologic technique for liposuction surgery because it is impossible to perform liposuction beyond infiltrated areas and because only smaller volumes of fat can be removed. To ensure safety, lidocaine levels should not exceed limits (35–55 mg/kg body weight). Removal of larger fat volumes should be performed in more than one procedure. Intravenous sedation or general anesthesia should be more carefully considered for this cosmetic procedure.

scholarly journals Junctional Rhythm Preoperatively and During General Anesthesia for Oral and Maxillofacial Surgery

2017 ◽  
Vol 64 (3) ◽  
pp. 165-167 ◽  
Author(s):  
Naotaka Kishimoto ◽  
Ikue Kinoshita ◽  
Yoshihiro Momota
Keyword(s):  
General Anesthesia ◽  
Local Anesthesia ◽  
Anesthetic Management ◽  
Maxillofacial Surgery ◽  
Oral And Maxillofacial Surgery ◽  
Anesthesia Induction ◽  
Sagittal Split Ramus Osteotomy ◽  
Junctional Rhythm ◽  
Appropriate Treatment ◽  
Slow Heart Rate

We report a case of junctional rhythm that occurred both preoperatively and later during a portion of general anesthesia. A 19-year-old woman was scheduled to undergo bilateral sagittal split ramus osteotomy after being diagnosed with a jaw deformity. Preoperative electrocardiography (ECG) revealed a junctional rhythm with a slow heart rate (HR). At 90 minutes after anesthesia induction, local anesthesia with 10 mL of 1% lidocaine and 1:100,000 adrenaline was administered. A junctional rhythm appeared 15 minutes after the local anesthesia. We believe that the atrioventricular nodal pacemaker cells accelerated because of the increased sympathetic activity due to the adrenaline. On the preoperative ECG, the junctional rhythm with slow HR appeared as an escaped beat caused by slowing of the primary pacemaker. Therefore, we think that the preoperative junctional rhythm and the junctional rhythm that appeared during general anesthesia were due to different causes. Understanding the cause of a junctional rhythm could lead to more appropriate treatment. We therefore believe that identifying the cause of the junctional rhythm is important in anesthetic management.

Improved hemostasis with superactive analogs of factor VIIa in a mouse model of hemophilia A

Blood ◽  
2003 ◽  
Vol 102 (10) ◽  
pp. 3615-3620 ◽  
Author(s):  
Mikael Tranholm ◽  
Kim Kristensen ◽  
Annemarie T. Kristensen ◽  
Charles Pyke ◽  
Rasmus Røjkjær ◽  
...  
Keyword(s):  
Blood Loss ◽  
Bleeding Time ◽  
Hemophilia A ◽  
Recombinant Factor Viia ◽  
Factor Viia ◽  
Intrinsic Activity ◽  
Hemostatic Effect ◽  
Therapeutic Doses ◽  
Hemostatic Effects

AbstractIt is currently debated whether the mechanism of action of therapeutic doses of recombinant factor VIIa (rFVIIa, Novo-Seven) relies on the tissue factor (TF)-independent activity of the enzyme. The present study was conducted to investigate the in vivo hemostatic effects of rFVIIa and 3 analogs thereof with superior intrinsic activity (FVIIaIIa, K337A-FVIIaIia, and M298Q-FVIIa) in mice with antibody-induced hemophilia A. A highly significant dose response was observed for the bleeding time and blood loss for each of the rFVIIa variants. The bleeding time and blood loss were normalized after administration of 10 mg/kg rFVIIa, 3 mg/kg K337A-FVIIaIia, and 3 mg/kg M298Q-FVIIa, indicating a potency of these FVIIa analogs 3-4 times above that of rFVIIa in FVIII-depleted mice. The different in vivo potencies of the various forms of FVIIa could not be explained by the pharmacokinetics. Histopathological evaluation of kidneys revealed no signs of treatment-related pathological changes even after treatment with the superactive variants. The fact that FVIIa analogs with enhanced intrinsic activity are more efficacious in the murine hemophilia A model strongly suggests that the TF-independent procoagulant activity of FVIIa contributes to its clinical hemostatic effect. (Blood. 2003; 102:3615-3620)

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