**7. Management of perioperative intravenous fluids**

For safety reasons, tumescent liposuction of large volumes is a surgery in which patients must stay at least 1 night hospitalized in an environment that guarantees their monitoring and safety. Often, there are patients who want extensive liposuction that can be as much as 30% of their total body surface, the remaining 70% will stay on the infiltrated tissues, and from there it will be reabsorbed, with the potential for fluid overload. Although the perioperative management of liquids during liposuction remains an unresolved controversy, especially in liposuction of large volumes, the current trend is to decrease the administration of liquids and sodium to avoid fluid overload, pulmonary edema, and congestive heart failure.

A recent study was done in China by Wang et al. [19], who retrospectively reviewed 83 medical records of patients who underwent extensive liposuction under intravenous monitored sedation with propofol 1–2 mg/kg/h and remifentanil 1–7 μg/kg/h. The intraoperative fluid ratio was 1.66 for extensive liposuction. These authors did not find cases of pulmonary edema, congestive heart failure, or other important complications. The average diuresis in the operating room, the recovery room, and in the surgical floors was 1.35, 2.3, and 1.4 mL/kg/h, respectively. The administration of intravenous fluids during liposuction decreased approximately 300–500 mL. The total volume of intravenous injection was also reduced to less than 1500 mL when the patient was in the recovery room and on the floor of the hospital. The Colombian Consensus recommends to consider the effect of dermoclysis of the tumescent solutions that are injected to the patients [20].

The liposuction removes approximately 30% of the infused tumescent solution, so for each liter of infiltrated tumescent solution, 700 mL are absorbed, so they should be considered as part of the fluids administered to the patient.

Another piece of information that can be used as a guide is to administer intravenous crystalloid solutions from 0.1 to 0.25 mL per mL of aspirate [21, 22].
