Spinal anesthesia for abdominoplasty with liposuction: a case report.

www.aana.com/aanajournal.aspx weeks before surgery because of the increased risk of deep vein thrombosis. On the day of surgery, preoperative vital signs were blood pressure, 122/74 mm Hg; heart rate, 52 beats per minute and regular; hemoglobin saturation, 100% on room air; respirations, regular and nonlabored at 16 breaths per minute. Upon entry to the operating room, an 18-gauge intravenous (IV) catheter was started for fluid preloading in preparation for the spinal anesthetic and monitors were placed. Following a 500-mL fluid bolus, the patient was placed in the sitting position for placement of the spinal anesthetic. Midazolam, 1 mg IV, was given for anxiolysis. The placement of the midline spinal was performed smoothly under aseptic conditions. One percent lidocaine was injected at the third and fourth lumbar interspace. A 25-gauge Pencan spinal needle (B. Braun Medical Inc, Bethlehem, Pa) was inserted at the same interspace via an introducer. Spinal bupivacaine, 13 mg, was slowly injected following visualization of the cerebral spinal fluid swirl in the syringe. The needle and introducer were removed intact. The patient was immediately placed in the supine position. Onset of the subarachnoid block was apparent at 30 to 60 seconds. The patient described tingling in her toes and warm legs. Following assessment of a T6 sensory level at approximately 4 minutes, the patient was prepped and draped for surgery. An indwelling urinary catheter was inserted. Pneumatic compression device stockings were placed on the legs. Intravenous sedation was begun using midazolam, 1 mg, and a propofol infusion at 75 μg/kg per minute. Surgery commenced 15 minutes following administration of the spinal anesthetic. The patient remained sedated for the duration of the procedure. Subarachnoid block is an appropriate anesthetic technique used for abdominoplasty with liposuction in the office-based setting. Strict compliance with standards of care for officebased anesthesia is essential for a successful perioperative anesthetic course without complications. Current research is limited on the safety and efficacy of spinal anesthesia for abdominoplasty in outpatient settings. While general anesthesia is routinely used for abdominoplasty, this surgical procedure can be performed using spinal anesthesia. Further research is necessary to fill the current void regarding spinal anesthesia and office-based surgical procedures.