To the Editor:
Tumescent anesthesia is a widely used technique for liposuction based on subcutaneous infiltration of a solution containing lidocaine and adrenaline. The use of diluted lidocaine allows administration of doses up to 35–55 mg/kg (1). Anesthesiologists can be confronted with tumescent liposuction, however, there is a lack of information concerning anesthetic considerations and the magnitude of safety of this procedure in the literature.
Tumescent liposuction should not be considered an absolutely safe procedure. It can be fatal (2). Cases of death have been described and, since reporting of adverse events associated with tumescent liposuction is not mandatory, the incidence of complications and deaths is unknown (2).
Anesthesiologists engaged in perioperative management of tumescent liposuction should be aware of the potential risk of lidocaine toxicity and lidocaine-related drug interactions (2). These, plus other possible perioperative complications such as pulmonary embolism, pulmonary edema, fluid imbalance, or hypothermia, mandate expansion of monitoring and resuscitative facilities when tumescent liposuction is performed (3).
Tumescent anesthesia, which may not be as safe as reputed, is a concern for anesthesiologists. Anesthetic considerations and magnitude of safety of tumescent liposuction need to be evaluated and discussed in comprehensive articles in anesthesia journals.
Zafer Salim Tabboush, MD
1. Ostad A. Kageyama, Moy RL. Tumescent anesthesia with a lidocaine dose of 55 mg/kg is safe for liposuction. Dermatol Surg 1996; 22: 921–7.
2. Rao RB, Ely SF, Hoffman RS. Deaths related to liposuction. N Engl J Med 1999; 13: 1471–5.
3. de Jong RH, Grazer FM. Perioperative management of cosmetic liposuction. Plast Reconstr Surg 2001; 4: 1039–44.