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SAFE Anesthesia and Minimizing Blood Loss

  • Eric Swanson
Chapter

Abstract

Enhanced recovery after surgery (ERAS) has received recent attention. Surgery has traditionally relied on the anesthesia provider to mask the pain centrally, with little regard for peripheral anesthesia at the tissue level.

General endotracheal anesthesia remains the most commonly used type of anesthesia for large body contouring cases. However, general anesthesia with muscle relaxation may be implicated in the formation of deep venous thromboses. Instead the author recommends SAFE (spontaneous breathing, avoid gas, face up, and extremities mobile) anesthesia. Total intravenous anesthesia maintains mean arterial blood pressure. Avoiding paralysis preserves the calf muscle pump. Other advantages derive from avoiding anesthetic gas, such as reducing the risk of postoperative nausea. Recovery times are quicker. Prone positioning, which adds unnecessary risks and operating time for patient positioning, may be eliminated.

Bupivacaine is a much longer-acting anesthetic than lidocaine, but it has been regarded with caution because of cardiac toxicity. The author evaluated plasma levels of this anesthetic when administered in a dilute form into the abdominal subcutaneous tissue before abdominoplasty. Plasma levels rose slowly, and a wide margin of safety was maintained. A bupivacaine infusion, using the body’s fat cells as a slow-release mechanism, offers a superior alternative to regional nerve blocks.

Evaluation of hematocrits after liposuction reveals substantial third-space blood loss into the tissues. Aspirate volumes >5 L are associated with an estimated blood loss of >1 L. The prudent surgeon will anticipate blood loss and avoid postoperative anemia. Simply using a superwet method rather than tumescent infusions makes patient overhydration unlikely.

The goal of surgery and anesthesia should be to minimize the physiological, metabolic, and hemodynamic impact of surgery so as to optimize safety and enhance the recovery.

Keywords

Anesthesia SAFE Total intravenous Bupivacaine Lidocaine Blood loss Liposuction Superwet Physiological 

References

  1. 1.
    Gupta V, Winocour J, Shi H, Shack RB, Grotting JC, Higdon KK. Preoperative risk factors and complication rates in facelift: analysis of 11,300 patients. Aesthet Surg J. 2016;36:1–13.PubMedCrossRefGoogle Scholar
  2. 2.
    Winocour J, Gupta V, Ramirez JR, Shack RB, Grotting JC, Higdon KK. Abdominoplasty: risk factors, complication rates, and safety of combined procedures. Plast Reconstr Surg. 2015;136:597e–606e.PubMedCrossRefGoogle Scholar
  3. 3.
    Swanson E. Lessons learned from a national cosmetic surgery insurance database. Aesthet Surg J. 2016;36:NP171–2.PubMedCrossRefGoogle Scholar
  4. 4.
    Klein JA. Tumescent technique for regional anesthesia permits lidocaine doses of 35 mg/kg for liposuction. J Dermatol Surg Oncol. 1990;16:248–63.PubMedCrossRefGoogle Scholar
  5. 5.
    Hetter GP. The effect of low dose epinephrine on the hematocrit drop following lipolysis. Aesthet Plast Surg. 1984;8:19–21.CrossRefGoogle Scholar
  6. 6.
    Maimon WN, Schuller DE. Lidocaine v bupivacaine in facial plastic surgery. A clinical trial. Arch Otolaryngol. 1984;110:525–8.PubMedCrossRefGoogle Scholar
  7. 7.
    Iverson RE, Lynch DJ, American Society of Plastic Surgeons Committee on Patient Safety. Practice advisory on liposuction. Plast Reconstr Surg. 2004;113:1478–90.PubMedCrossRefGoogle Scholar
  8. 8.
    Haeck PC, Swanson JA, Gutowski KA, American Society of Plastic Surgery Patient Safety Committee, et al. Evidence-based patient safety advisory: liposuction. Plast Reconstr Surg. 2009;124(Suppl):28S–44S.PubMedCrossRefGoogle Scholar
  9. 9.
    Mustoe TA, Buck DW, Lalonde DH. The safe management of anesthesia, sedation, and pain in plastic surgery. Plast Reconstr Surg. 2010;126:165e–76e.PubMedCrossRefGoogle Scholar
  10. 10.
    Swanson E. Prospective study of lidocaine, bupivacaine and epinephrine levels and blood loss in patients undergoing liposuction and abdominoplasty. Plast Reconstr Surg. 2012;130:702–22. discussion 723–5PubMedCrossRefGoogle Scholar
  11. 11.
    Burk RW, Guzman-Stein G, Vasconez LO. Lidocaine and epinephrine levels in tumescent technique liposuction. Plast Reconstr Surg. 1996;97:1379–84.PubMedCrossRefGoogle Scholar
  12. 12.
    Brown SA, Lipschitz AH, Kenkel JM, et al. Pharmacokinetics and safety of epinephrine use in liposuction. Plast Reconstr Surg. 2004;114:756–63. discussion 764–5PubMedCrossRefGoogle Scholar
  13. 13.
    Swanson E. Prospective clinical study reveals significant reduction in triglyceride level and white cell count after liposuction and abdominoplasty and no change in cholesterol levels. Plast Reconstr Surg. 2011;128:182e–97e.PubMedCrossRefGoogle Scholar
  14. 14.
    Swanson E. The case against chemoprophylaxis for venous thromboembolism prevention and the rationale for SAFE anesthesia. Plast Reconstr Surg Glob Open. 2014;2:e160.PubMedPubMedCentralCrossRefGoogle Scholar
  15. 15.
    Pitman GH, Aker JS, Tripp ZD. Tumescent liposuction. A surgeon’s perspective. Clin Plast Surg. 1996;23:633–45.PubMedGoogle Scholar
  16. 16.
    Gross JB. Estimating allowable blood loss: corrected for dilution. Anesthesiology. 1983;58:277–80.PubMedCrossRefGoogle Scholar
  17. 17.
    Matarasso A. Lidocaine in ultrasound-assisted lipoplasty. Clin Plast Surg. 1999;26:431–9.PubMedGoogle Scholar
  18. 18.
    Grazer FM. Discussion. Quantitative analysis of blood and fat in suction lipectomy aspirates. Plast Reconstr Surg. 1986;78:770–2.CrossRefGoogle Scholar
  19. 19.
    Ostad A, Kageyama N, Moy RL. Tumescent anesthesia with lidocaine dose of 55 mg/kg is safe for liposuction. Dermatol Surg. 1996;22:921–7.PubMedGoogle Scholar
  20. 20.
    Fodor PB, Watson J. Personal experience with ultrasound-assisted lipoplasty: a pilot study comparing ultrasound-assisted lipoplasty with traditional lipoplasty. Plast Reconstr Surg. 1998;101:1103–16.PubMedCrossRefGoogle Scholar
  21. 21.
    Samdal F, Amland PF, Bugge JF. Plasma lidocaine levels during suction-assisted lipectomy using large doses of dilute lidocaine with epinephrine. Plast Reconstr Surg. 1994;93:1217–23.PubMedCrossRefGoogle Scholar
  22. 22.
    Hatef DA, Brown SA, Lipschitz AH, Kenkel JM. Efficacy of lidocaine for pain control in subcutaneous infiltration during liposuction. Aesthet Surg J. 2009;29:122–8.PubMedCrossRefGoogle Scholar
  23. 23.
    Rubin JP, Bierman C, Rosow CE, et al. The tumescent technique: the effect of high tissue pressure and dilute epinephrine on absorption of lidocaine. Plast Reconstr Surg. 1999;103:990–6. discussions 997–1002PubMedCrossRefGoogle Scholar
  24. 24.
    Kenkel JM, Lipschitz AH, Shepherd G, et al. Pharmokinetics and safety of lidocaine and monoethylglycinexylidide in liposuction: a microdialysis study. Plast Reconstr Surg. 2004;114:516–24. discussion 525–6PubMedCrossRefGoogle Scholar
  25. 25.
    Jones BM, Grover R. Reducing complications in cervicofacial rhytidectomy by tumescent infiltration: a comparative trial evaluating 678 consecutive face lifts. Plast Reconstr Surg. 2004;113:398–403.PubMedCrossRefGoogle Scholar
  26. 26.
    Mottura AA. Local infiltrative anesthesia for transaxillary subpectoral breast implants. Aesthet Plast Surg. 1995;19:37–9.CrossRefGoogle Scholar
  27. 27.
    Kazmier FR, Henry SL, Christiansen D, Puckett CL. A prospective, randomized, double-blind controlled trial of continuous local anesthetic infusion in cosmetic breast augmentation. Plast Reconstr Surg. 2008;121:711–5.PubMedCrossRefGoogle Scholar
  28. 28.
    McCarthy CM, Pusic AL, Hidalgo DA. Efficacy of pocket irrigation with bupivacaine and ketorolac in breast augmentation: a randomized controlled trial. Ann Plast Surg. 2009;62:15–7.PubMedCrossRefGoogle Scholar
  29. 29.
    Zukowski ML, Ash K, Klink B, Reid D, Messa A. Breast reduction under intravenous sedation: a review of 50 cases. Plast Reconstr Surg. 1996;97:952–6.PubMedCrossRefGoogle Scholar
  30. 30.
    Heller L, Kowalski AM, Wei C, Butler CE. Prospective, randomized double-blind trial of local anesthetic infusion and intravenous narcotic patient-controlled anesthesia pump for pain management after free TRAM flap breast reconstruction. Plast Reconstr Surg. 2008;122:1010–8.PubMedCrossRefGoogle Scholar
  31. 31.
    Gilliland MD, Commons GW, Halperin B. Safety issues in ultrasound-assisted large-volume lipoplasty. Clin Plast Surg. 1999;26:317–35.PubMedGoogle Scholar
  32. 32.
    Fodor PB, Watson JP. Wetting solutions in ultrasound-assisted lipoplasty. Clin Plast Surg. 1999;26:289–93.PubMedGoogle Scholar
  33. 33.
    Commons GW, Halperin B, Chang CC. Large-volume liposuction: a review of 631 cases over 12 years. Plast Reconstr Surg. 2001;108:1753–63. discussions 1764–7PubMedCrossRefGoogle Scholar
  34. 34.
    Failey CL, Vemula R, Borah GL, Hsia HC. Intraoperative use of bupivacaine for tumescent liposuction: the Robert Wood Johnson experience. Plast Reconstr Surg. 2009;124:1304–11.PubMedCrossRefGoogle Scholar
  35. 35.
    Mottura AA. Local anesthesia for abdominoplasty, liposuction, and combined operations. Aesthet Plast Surg. 1993;17(2):117–24.CrossRefGoogle Scholar
  36. 36.
    Abramson DL. Tumescent abdominoplasty: an ambulatory office procedure. Aesthet Plast Surg. 1998;22:404–7.CrossRefGoogle Scholar
  37. 37.
    Spiegelman JI, Levine RH. Abdominoplasty: a comparison of outpatient and inpatient procedures shows that it is a safe and effective procedure for outpatients in an office-based surgery clinic. Plast Reconstr Surg. 2006;118:517–22. discussion 523–4PubMedCrossRefGoogle Scholar
  38. 38.
    Michaels BM, Eko FN. Outpatient abdominoplasty facilitated by rib blocks. Plast Reconstr Surg. 2009;124:635–42.PubMedCrossRefGoogle Scholar
  39. 39.
    Feng L-J. Painless abdominoplasty: the efficacy of combined intercostal and pararectus blocks in reducing postoperative pain and recovery time. Plast Reconstr Surg. 2010;126:1723–32. discussion 733–4PubMedCrossRefGoogle Scholar
  40. 40.
    Shiffman MA. The future of liposuction and fat. Plast Reconstr Surg. 2000;106:505.PubMedCrossRefGoogle Scholar
  41. 41.
    Klein JA. Intravenous fluids and bupivacaine are contraindicated in tumescent liposuction. Plast Reconstr Surg. 1998;102:2516–8.PubMedCrossRefGoogle Scholar
  42. 42.
    Albright GA. Cardiac arrest following regional anesthesia with etidocaine or bupivacaine. Anesthesiology. 1979;51:285–7.PubMedCrossRefGoogle Scholar
  43. 43.
    Katz RL. Reply. Intravenous fluids and bupivacaine are contraindicated in tumescent liposuction. Plast Reconstr Surg. 1998;102:2519.CrossRefGoogle Scholar
  44. 44.
  45. 45.
    Rosenblatt MA, Abel M, Fischer G, et al. Successful use of a 20% lipid emulsion to resuscitate a patient after a presumed bupivacaine-related cardiac arrest. Anesthesiology. 2006;105:217–8.PubMedCrossRefGoogle Scholar
  46. 46.
    Whiteman DM, Kushins SI. Successful resuscitation with intralipid after marcaine overdose. Aesthet Surg J. 2014;34:738–40.PubMedCrossRefGoogle Scholar
  47. 47.
    Rao RB, Ely SF, Hoffman RS. Deaths related to liposuction. N Engl J Med. 1999;340:1471–5.PubMedCrossRefGoogle Scholar
  48. 48.
    Paik AM, Daniali LN, Lee ES, Hsia HC. Local anesthetic use in tumescent liposuction: an American Society of Plastic Surgeons (ASPS) survey. Plast Reconstr Surg. 2013:74.Google Scholar
  49. 49.
    Tuominen M, Rosenberg PH, Kalso E. Blood levels of bupivacaine after single dose, supplementary dose and during continuous infusion in axillary plexus block. Acta Anaesthesiol Scand. 1983;27:303–6.PubMedCrossRefGoogle Scholar
  50. 50.
    Samdal F, Amland PF, Bugge JF. Blood loss during liposuction using the tumescent technique. Aesthet Plast Surg. 1994;18:157–60.CrossRefGoogle Scholar
  51. 51.
    Scarborough DA, Herron JB, Khan A, Bisaccia E. Experience with more than 5,000 cases in which monitored anesthesia care was used for liposuction surgery. Aesthet Plast Surg. 2004;27:474–80.Google Scholar
  52. 52.
    Rohrich RJ, Beran SJ, Fodor PB. The role of subcutaneous infiltration in suction-assisted lipoplasty: a review. Plast Reconstr Surg. 1997;99:514–9. discussions 520–6PubMedCrossRefGoogle Scholar
  53. 53.
    Swanson E. Avoiding postoperative nausea and improving pain management using total IV anesthesia. Presented at ASPS aesthetica symposium, New Orleans, LA, 2–4 Mar 2017.Google Scholar
  54. 54.
    Janis J. Multimodal oral analgesia. Presented at ASPS aesthetica symposium. New Orleans, 2–4 Mar 2017.Google Scholar
  55. 55.
    Thomson CJ, Lalonde DH. Randomized double-blind comparison of duration of anesthesia among three commonly used agents in digital nerve block. Plast Reconstr Surg. 2006;118:429–32.PubMedCrossRefGoogle Scholar
  56. 56.
    Kryger ZB, Fine NA, Mustoe TA. The outcome of abdominoplasty performed under conscious sedation: six-year experience in 153 consecutive cases. Plast Reconstr Surg. 2004;113:1807–17. discussion 1818–9PubMedCrossRefGoogle Scholar
  57. 57.
    Kenkel JM, Lipschitz AH, Luby M, et al. Hemodynamic physiology and thermoregulation in liposuction. Plast Reconstr Surg. 2004;114:503–13. discussion 514–5PubMedCrossRefGoogle Scholar
  58. 58.
    Dunlevy TM, O’Malley TP, Postma GN. Optimal concentration of epinephrine for vasoconstriction in neck surgery. Laryngoscope. 1996;106:1412–4.PubMedCrossRefGoogle Scholar
  59. 59.
    Byun MY, Fine NA, Lee JYY, Mustoe TA. The clinical outcome of abdominoplasty performed under conscious sedation: increased use of fentanyl correlated with longer stay in outpatient unit. Plast Reconstr Surg. 1999;103:1260–6.PubMedCrossRefGoogle Scholar
  60. 60.
    Swanson E. A physiological pain pump for abdominoplasty: an alternative to regional blocks and liposomal bupivacaine. Plast Reconstr Surg. 2015;136:714e–6e.PubMedCrossRefGoogle Scholar
  61. 61.
    Mustoe TA. Discussion. Abdominoplasty: a comparison of outpatient and inpatient procedures shows that it is a safe and effective procedure for outpatients in an office-based surgery clinic. Plast Reconstr Surg. 2006;118:523–4.CrossRefGoogle Scholar
  62. 62.
    Ersek RA. Fatal pulmonary embolism. Letter. Plast Reconstr Surg. 2004;113:1868.PubMedCrossRefGoogle Scholar
  63. 63.
    Friedberg BL. Lethal pulmonary embolisms are avoidable. Plast Reconstr Surg. 2009;123:768.PubMedCrossRefGoogle Scholar
  64. 64.
    Pannucci CJ, MacDonald JK, Ariyan S, et al. Benefits and risks of prophylaxis for deep venous thrombosis and pulmonary embolus in plastic surgery: a systematic review and meta-analysis of controlled trials and consensus conference. Plast Reconstr Surg. 2016;137:709–30.PubMedCrossRefGoogle Scholar
  65. 65.
    Swanson E, Gordon R. Comparing a propofol infusion with general endotracheal anesthesia in plastic surgery patients. Aesthet Surg J. 2017;37:NP48–50.PubMedCrossRefGoogle Scholar
  66. 66.
    Gurunluoglu R, Swanson JA, Haeck PC, The ASPS Patient Safety Committee. Evidence-based patient safety advisory: malignant hyperthermia. Plast Reconstr Surg. 2009;124(Suppl):68S–81S.PubMedCrossRefGoogle Scholar
  67. 67.
    Hatef DA, Kenkel JM, Nguyen MQ, et al. Thromboembolic risk assessment and the efficacy of enoxaparin prophylaxis in excisional body contouring surgery. Plast Reconstr Surg. 2008;122:269–79.PubMedCrossRefGoogle Scholar
  68. 68.
    Buck DW, Mustoe TA. An evidence-based approach to abdominoplasty. Plast Reconstr Surg. 2010;126:2189–95.PubMedCrossRefGoogle Scholar
  69. 69.
    Hamer JD, Malone PC, Silver IA. The PO2 in venous valve pockets: its possible bearing on thrombogenesis. Br J Surg. 1981;68:166–70.PubMedCrossRefGoogle Scholar
  70. 70.
    Flanders SA, Greene MT, Grant P, et al. Hospital performance for pharmacologic venous thromboembolism prophylaxis and rate of venous thromboembolism: a cohort study. JAMA Intern Med. 2014;174:1577–84.PubMedCrossRefGoogle Scholar
  71. 71.
    Nelson DW, Simianu VV, Bastawrous AL, et al. Thromboembolic complications and prophylactic patterns in colorectal surgery. JAMA Surg. 2015;150:712–20.PubMedCrossRefGoogle Scholar
  72. 72.
    Sharrock NE, Gonzalez Della Valle A, Go G, Lyman S, Salvati EA. Potent anticoagulants are associated with a higher all-cause mortality rate after hip and knee arthroplasty. Clin Orthop Relat Res. 2008;466:714–21.PubMedPubMedCentralCrossRefGoogle Scholar
  73. 73.
    Swanson E. Prospective clinical study of 551 cases of liposuction and abdominoplasty performed individually and in combination. Plast Reconstr Surg Glob Open. 2013;1:e32.PubMedPubMedCentralCrossRefGoogle Scholar
  74. 74.
    Swanson E. Ultrasound screening for deep venous thrombosis detection: prospective evaluation of 200 plastic surgery outpatients. Plast Reconstr Surg Glob Open. 2015;3:e332.PubMedPubMedCentralCrossRefGoogle Scholar
  75. 75.
    Stuzin JM, Baker TJ, Baker TM. Deep venous thrombosis and pulmonary embolus after face lift: a study of incidence and prophylaxis (Discussion). Plast Reconstr Surg. 2001:1576–7.Google Scholar
  76. 76.
    Bitar G, Mullis W, Jacobs W, et al. Safety and efficacy of office-based surgery with monitored anesthesia care/sedation in 4778 consecutive plastic surgery procedures. Plast Reconstr Surg. 2003;111:150–6. discussion 157–8PubMedCrossRefGoogle Scholar
  77. 77.
    Ersek RA. Dissociative anesthesia for safety’s sake: ketamine and diazepam – a 35-year personal experience. Plast Reconstr Surg. 2004;113:1955–9.PubMedCrossRefGoogle Scholar
  78. 78.
    Reinisch JF, Bresnick SD, Walker JWT, Rosso RF. Deep venous thrombosis and pulmonary embolus after face lift: a study of incidence and prophylaxis. Plast Reconstr Surg. 2001;107:1570–5. discussion 1576–7PubMedCrossRefGoogle Scholar
  79. 79.
    Bray DA Jr, Nguyen J, Craig J, Cohen BE, Collins DR Jr. Efficacy of a local anesthetic pain pump in abdominoplasty. Plast Reconstr Surg. 2007;119:1054–9.PubMedCrossRefGoogle Scholar
  80. 80.
    Fiala T. Transversus abdominis plane block during abdominoplasty to improve postoperative patient comfort. Aesthet Surg J. 2015;35:72–80.PubMedCrossRefGoogle Scholar
  81. 81.
    Joshi G. Improve patient safety and satisfaction in body contouring through multimodal analgesia. Presented at American Society of Plastic Surgeons Aesthetica Meeting, Las Vegas, 1 May 2015.Google Scholar
  82. 82.
    Matarasso A. Improve patient safety and satisfaction in body contouring through multimodal analgesia. Presented at American Society of Plastic Surgeons Aesthetica Meeting, Las Vegas, 1 May 2015.Google Scholar
  83. 83.
    Huang GJ, Bajaj AK, Gupta S, Petersen F, Miles DAG. Increased intraabdominal pressure in abdominoplasty: delineation of risk factors. Plast Reconstr Surg. 2007;119:1319–25.PubMedCrossRefGoogle Scholar
  84. 84.
    Matarasso A. Abdominolipoplasty. Clin Plast Surg. 1989;16:289–303.PubMedGoogle Scholar
  85. 85.
    Trott SA, Beran SJ, Rohrich RJ, Kenkel JM, Adams WP, Klein KW. Safety considerations and fluid resuscitation in liposuction: an analysis of 53 consecutive patients. Plast Reconstr Surg. 1998;102:2220–9.PubMedCrossRefGoogle Scholar
  86. 86.
    Cárdenas-Camarena L, Tobar-Losada A, Lacouture AM. Large-volume circumferential liposuction with tumescent technique: a sure and viable procedure. Plast Reconstr Surg. 1999;104:1887–99.PubMedCrossRefGoogle Scholar
  87. 87.
    Cárdenas-Camarena L, González LE. Large-volume liposuction and extensive abdominoplasty: a feasible alternative for improving body shape. Plast Reconstr Surg. 1998;102:1698–707.PubMedCrossRefGoogle Scholar
  88. 88.
    Hunstad JP, Aitken ME. Liposuction and tumescent surgery. Clin Plast Surg. 2006;33:39–46.PubMedCrossRefGoogle Scholar
  89. 89.
    Gilliland MD, Coates N. Tumescent liposuction complicated by pulmonary edema. Plast Reconstr Surg. 1997;99:215–9.PubMedCrossRefGoogle Scholar
  90. 90.
    Fodor PB. Editorial. Wetting solutions in aspirative lipoplasty: a plea for safety in liposuction. Aesthet Plast Surg. 1995;19:379–80.CrossRefGoogle Scholar
  91. 91.
    Liu AS, Nargozian C, Greene AK. Subcutaneous epinephrine for vasoconstriction: an evidence-based evaluation. Plast Reconstr Surg. 2010;126:157e–8e.PubMedCrossRefGoogle Scholar
  92. 92.
    O’Malley TP, Postma GN, Holtel M, Girod DA. Effect of local epinephrine on cutaneous bloodflow in the human neck. Laryngoscope. 1995;105:140–3.PubMedCrossRefGoogle Scholar
  93. 93.
    Clutter WE, Bier DM, Shah SD, et al. Epinephrine plasma metabolic clearance rates and physiologic thresholds for metabolic and hemodynamic actions in man. J Clin Invest. 1980;66:94–101.PubMedPubMedCentralCrossRefGoogle Scholar
  94. 94.
    Butterwick KJ, Goldman MP, Sriprachya-Anunt S. Lidocaine levels during the first two hours of infiltration of dilute anesthetic solution for tumescent liposuction: rapid versus slow delivery. Dermatol Surg. 1999;25:681–5.PubMedCrossRefGoogle Scholar
  95. 95.
    Chapin JC, Kushins LG, Munson ES, Schick LM. Lidocaine, bupivacaine, etidocaine, and epinephrine-induced arrhythmias during halothane anesthesia in dogs. Anesthesiology. 1980;52:23–6.PubMedCrossRefGoogle Scholar
  96. 96.
    Kulier AH, Woehlck HJ, Hogan QH, et al. Epinephrine dysrhythmogenicity is not enhanced by subtoxic bupivacaine in dogs. Anesth Analg. 1996;83:62–7.PubMedCrossRefGoogle Scholar
  97. 97.
  98. 98.
    Rohrich RJ, Kenkel JM, Janis JE, Beran SJ. Fodor. An update on the role of subcutaneous infiltration in suction-assisted lipoplasty. Plast Reconstr Surg. 2003;111:926–7. discussion 928PubMedCrossRefGoogle Scholar
  99. 99.
    Giese SY, Bulan EJ, Commons GW, Spear SL, Yanovski JA. Improvements in cardiovascular risk profile with large-volume liposuction: a pilot study. Plast Reconstr Surg. 2001;108:510–9.PubMedCrossRefGoogle Scholar
  100. 100.
    Goodpasture JC, Bunkis J. Quantitative analysis of blood and fat in suction lipectomy aspirates. Plast Reconstr Surg. 1986;78:765–72.PubMedCrossRefGoogle Scholar
  101. 101.
    Hetter GP, Herhahn F. Experience with “lipolysis”: the Illouz technique of blunt suction lipectomy in North America. Aesthet Plast Surg. 1983;7:69–76.CrossRefGoogle Scholar
  102. 102.
    Chappell D, Jacob M, Hofmann-Kiefer K, Conzen P, Rehm M. A rational approach to perioperative fluid management. Anesthesiology. 2008;109:723–40.PubMedCrossRefGoogle Scholar
  103. 103.
    Rohrich RJ, Beran SJ. Is liposuction safe? Plast Reconstr Surg. 1999;104:819–22.PubMedCrossRefGoogle Scholar
  104. 104.
    Hagerty T, Klein P. Fat partitioning of lidocaine in tumescent liposuction. Ann Plast Surg. 1999;42:372–5.PubMedCrossRefGoogle Scholar
  105. 105.
    Hardy SP, Ortiz-Colberg R, Poquette MA. Re: fat partitioning of lidocaine in tumescent liposuction. Ann Plast Surg. 1999;43:574.PubMedCrossRefGoogle Scholar
  106. 106.
    Gumucio CA, Bennie JB, Fernando B, Young VL, Roa N, Kraemer BA. Plasma lidocaine levels during augmentation mammoplasty and suction-assisted lipectomy. Plast Reconstr Surg. 1989;84:624–7.PubMedCrossRefGoogle Scholar
  107. 107.
    Facchinetti A, Sparacino G, Cobelli C. Reconstruction of glucose in plasma from interstitial fluid continuous glucose monitoring data: role of sensor calibration. J Diabetes Sci Technol. 2007;1(5):617–23.PubMedPubMedCentralCrossRefGoogle Scholar
  108. 108.
    Boyne MS, Silver DM, Kaplan J, Saudek CD. Timing of changes in interstitial and venous blood glucose measured with a continuous subcutaneous glucose sensor. Diabetes. 2003;52:2790–4.PubMedCrossRefGoogle Scholar
  109. 109.
    Kulku E, Tamada JA, Reach G, Potts RO, Lesho MJ. Physiological differences between interstitial glucose and blood glucose measured in human subjects. Diabetes Care. 2003;26:2405–9.CrossRefGoogle Scholar
  110. 110.
    Hahn RG. Influence of the fluid balance on the cortisol and glucose responses to transurethral prostatic resection. Acta Anaesthesiol Scand. 1989;33:638–41.PubMedCrossRefGoogle Scholar
  111. 111.
    Piros D, Fagerström T, Collins JW, Hahn RG. Glucose as a marker of fluid absorption in bipolar transurethral surgery. Anes Anal. 2009;109:1850–5.CrossRefGoogle Scholar
  112. 112.
    Thomas JT, Chawla A, Thomas J. Serum glucose as a predictor of fluid absorption during transurethral bipolar prostatic surgery. Ind J Urol. 2010;26:466–8.Google Scholar
  113. 113.
    Lipschitz AH, Kenkel JM, Luby M, Sorokin E, Rohrich RJ, Brown SA. Electrolyte and plasma enzyme analyses during large-volume liposuction. Plast Reconstr Surg. 2004;114:766–75. discussion 776–7PubMedCrossRefGoogle Scholar
  114. 114.
    Kenkel JM, Brown SA, Love EJ, et al. Hemodynamics, electrolytes, and organ histology of larger-volume liposuction in a porcine model. Plast Reconstr Surg. 2004;113:1391–9.PubMedCrossRefGoogle Scholar
  115. 115.
    El-Ali KM, Gourlay T. Assessment of the risk of systemic fat mobilization and fat embolism as a consequence of liposuction: ex vivo study. Plast Reconstr Surg. 2006;117:2269–76.PubMedCrossRefGoogle Scholar
  116. 116.
    Yasny JS, White J. Environmental implications of anesthetic gases. Anesth Prog. 2012;59:154–8.Google Scholar
  117. 117.
    MacNeill AJ, Lillywhite R, Brown CJ. The impact of surgery on global climate: a carbon footprinting study of operating theatres in three health systems. Lancet Planetary Health. 2017;1:e381–8.Google Scholar

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© Springer International Publishing AG 2018

Authors and Affiliations

  • Eric Swanson
    • 1
  1. 1.Swanson CenterLeawoodUSA

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