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Deaths Related to Liposuction
Liposuction is the cosmetic operation performed most commonly in the U.S. Tumescent liposuction, developed by dermatologists, involves subcutaneous infusion of a saline solution of dilute lidocaine, epinephrine, and sodium bicarbonate followed by aspiration of fat through small cannulas. Although it is safer than older liposuction methods because it does not require general anesthesia, fluid replacement, or blood transfusions, the true incidence of death associated with the procedure is unknown. In this retrospective study, 5 of 1,001 deaths associated with therapeutic complications recorded by the New York City medical examiner between 1993 and 1998 were related to liposuction.
All five deaths occurred during or after tumescent liposuction. Four were performed by plastic surgeons and one by a general surgeon. An anesthesiologist was present at all procedures; two patients received general anesthesia, two were sedated intravenously, and in one case the anesthesia was not reported. Infused doses of lidocaine ranged from 10 to 40 mg/kg. Postmortem lidocaine levels in the three patients tested ranged from 2 to 5.2 mg/liter. One patient died from pulmonary embolism, one from fluid overload, and three from hypotension and bradycardia about two hours into the procedure.
Comment: Several hundred thousand people will undergo liposuction within the next year. The majority will have an uneventful course, but death, though extremely rare, is a potential complication. It is not clear what caused the hypotension and bradycardia in the three patients in this report. Therefore, deaths related to liposuction need to be reported and investigated. Tumescent infusion of dilute lidocaine with epinephrine has been demonstrated to be safe in doses up to 55 mg/kg, but the distribution of lidocaine from fat into the vasculature may depend on many factors including pH of the infusate. Further, the concentration of lidocaine may climb precipitously when the metabolizing pathway (CYP3A4) is saturated by high doses of lidocaine, or if other drugs inhibit its metabolism. The safety of tumescent liposuction can be improved by avoiding intravenous sedation and general anesthesia, infusing the tumescent solution slowly, staying within recommended dilute lidocaine dosage limits, and limiting the amount of fat aspirated in one session.
— NH Shear and GJ Hruza
Published in Journal Watch Dermatology June 1, 1999
Citation(s):
Rao RB et al. Deaths related to liposuction. N Engl J Med 1999 340 1471-1475.
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