Perioperative management of cosmetic liposuction.

摘要: Recent qualms about the safety of aesthetic lipoplasty may be attributable more to support system flaws than technical process deficiencies. The authors here focus on perfunctory patient monitoring when sedative or analgesic drugs are given, cavalier infiltration mega-dose lidocaine, cursory intraoperative observation by team members with conflicting responsibilities, anesthesia providers unfamiliar unique surgical physiology liposuction, hurried-discharge policies that virtually ignore residual depressant effects sedatives and analgesics, compressive dressings impair postoperative chest-wall expansion venous return. Whereas pulmonary embolism remains leading cause morbidity from complications austere resource allocation dedicated should largely preventable. Not all lipoplasties require an provider but-when heavy sedation, both, projected-a trained member exclusively comfort a minimum care standard. potential role lidocaine cardiotoxicity in tumescent is widely underappreciated hypothermia goes mostly unrecognized. These, plus preventable potentially correctable perioperative events such as edema, fluid imbalance, improperly administered drugs, demand upgrading monitoring, resuscitative, recuperative facilities physician offices. In fact, ASPS guidelines urge services engaged for whenever "major" liposuction conscious sedation projected, because neither benign nor simple procedure heretofore reputed. To assess objectively operative anesthetic risk obesity, document body mass index preoperative record; morbid obesity (body >/= 35.0), instance, known multiplier analgesics. Other issues dynamic profile high-dose pharmacokinetics, deportation fat globules bloodstream, incidence remain unresolved topics interdisciplinary, multi-institutional clinical research.