**2. Types of liposuction**

According to the infiltration techniques for liposuction, this procedure can be classified into four categories [6]:


Liposuction can also be classified into two types according to the aspirated volume: large volume (>4 liters aspirated) and low volume (<4 liters aspirated). From here we must always keep in mind that the higher the volume aspirated, almost inevitably a greater amount of tumescent solution will have to be infiltrated in the dermoclysis. As this volume of infiltration increases, so does the risk of causing pulmonary edema, for which in these conditions the management of intravenous fluids must be very cautious, always tending to the restriction both in the transoperative period and in the first hours of postanesthetic

**Figure 2.** The left image shows little blood compared to the image on the right with a large amount of blood in the

**Figure 1.** Abdomen infiltrated with 6 liters of tumescent solution. Note the pale coloration of the skin secondary to the

Anesthesia Management for Large-Volume Liposuction http://dx.doi.org/10.5772/intechopen.83630 73

According to the surgical instruments used, liposuction is called power-assisted, laserassisted, or ultrasonic-assisted lipoplasty. Manual liposuction using different sizes of syringes

recovery (**Figure 2**).

liposuction container.

effect of injected adrenaline.

is a technique that is still used for small areas.


Kesserling and Meyer, the Fischers, and many more. The technique was again modified in 1977 by the French surgeon, Yves Gerard Illouz, who added hyaluronidase and saline solution to try to emulsify the fat and facilitate its aspiration, later called the wet technique [1–3]. It was not until the mid-1980s that the American dermatologist, Klein, described the tumescent technique, in which considerable amounts of sodium chloride solution, local anesthetic, epinephrine, and bicarbonate were infiltrated in the fatty tissue to expand and increase its turgor in order to create a level to facilitate the suction and reduce blood losses [4]. During tumescent liposuction a variable amount of crystalloid solution is infused, including dissolved epinephrine to thicken the subcutaneous fat layer in order to remove the highest possible amount of fat, thus decreasing blood loss to amounts as low as 1% of all the aspirated volume. Lidocaine can be added to the solution to produce local anesthesia during and after

Although liposuction appears to be easy and harmless, it is not a trivial procedure because it can potentially involve serious complications like deep vein thrombosis (DVT), pulmonary embolism (PE), pulmonary edema, fat embolism, hypothermia, and even death [3, 5]. A painful recovery is also possible. Large-volume liposuction needs special care to avoid hypother-

This chapter focuses on large-volume liposuction done under general anesthesia, the most important technical aspects and literature data regarding risks, complications, and anesthe-

According to the infiltration techniques for liposuction, this procedure can be classified into

**1.** Dry technique: In which the aspiration cannula is inserted directly into the space from which the fat will be removed without any infiltration of the tissues. The estimated blood

**2.** Wet technique: In relation to the expected amount of aspirated volume, 200–300 ml of solution is injected in each area to be treated. Blood losses are calculated from 4 to 30% of

**3.** Super wet technique: The amount of infiltrated solution (calculated in 1 ml for each ml of the aspirated estimate) is equal to the amount of fat removed. Blood losses are calculated

**4.** Tumescent method: A large amount of solution (estimated at 3–4 ml per ml expected to be aspirated) is injected into the fatty tissue, seeking to increase the space occupied by the fat, in addition to giving it a firm and turgid consistency (**Figure 1**). Blood losses are calculated

mia, keep an appropriate fluid balance and DVT/PE prophylaxis.

losses range from 20 to 45% of the aspirated volume.

the procedure.

72 Anesthesia Topics for Plastic and Reconstructive Surgery

siological considerations.

**2. Types of liposuction**

the volume aspirated.

at 1% of the volume aspirated.

at 1% of the aspirated volume.

four categories [6]:

**Figure 1.** Abdomen infiltrated with 6 liters of tumescent solution. Note the pale coloration of the skin secondary to the effect of injected adrenaline.

**Figure 2.** The left image shows little blood compared to the image on the right with a large amount of blood in the liposuction container.

Liposuction can also be classified into two types according to the aspirated volume: large volume (>4 liters aspirated) and low volume (<4 liters aspirated). From here we must always keep in mind that the higher the volume aspirated, almost inevitably a greater amount of tumescent solution will have to be infiltrated in the dermoclysis. As this volume of infiltration increases, so does the risk of causing pulmonary edema, for which in these conditions the management of intravenous fluids must be very cautious, always tending to the restriction both in the transoperative period and in the first hours of postanesthetic recovery (**Figure 2**).

According to the surgical instruments used, liposuction is called power-assisted, laserassisted, or ultrasonic-assisted lipoplasty. Manual liposuction using different sizes of syringes is a technique that is still used for small areas.
