Anesthesia considerations in large-volume lipoplasty.

BACKGROUND Large-volume lipoplasty is becoming more common and has been proven to be safe and effective. Large-volume lipoplasty is normally performed with the patient under general anesthesia. Techniques of general anesthesia and fluid management are important factors in improving the safety of large-volume lipoplasty. OBJECTIVE Certain important considerations in anesthesia and perioperative management can improve outcomes in large-volume lipoplasty. Our objective is to present our protocol and technique for general anesthesia in large-volume lipoplasty METHODS Large-volume lipoplasty (5 to 18.5 L) was performed on 32 patients under general endotracheal anesthesia. Important considerations included proper selection of patients, low flow of anesthesia gases, prevention of hypothermia, deep vein thrombosis prophylaxis, intraoperative fluid ratio of 1, Foley catheter to monitor urine output, and postoperative overnight or longer monitoring in a well-equipped hospital. Maintaining the endotracheal cuff pressure between 20 to 30 mm of water helped to reduce incidence of sore throat. Addition of lidocaine in wetting solution helped to reduce requirement of general anesthetic agents and as a result, postoperative recovery was faster and more pleasant. RESULTS Major complications did not occur in any patients. Minor complications encountered were nausea, vomiting, and shivering and occurred in about 25% of patients. All patients were able to walk without support 4 hours after surgery. In spite of minor complications, all patients reported the postoperative recovery to be better than expected. CONCLUSIONS General anesthesia for large-volume lipoplasty is safe. Postoperative recovery can be made faster and more pleasant by following these recommendations.