Plastics part 2 Flashcards
Describe the possible abdominal surgeries.
liposuction abdominoplasty abdominal muscle repair 360 degree liposuction "mommy makeover" tummy tuck
______ has the highest morbidity & mortality
Liposuction****
Liposuction involves
removing fat from unwanted areas
abdomen, hips, waist, torso, neck, extremities, pectoral region
With liposuction, the preop evaluation should assess for
cardiomyopathy, pulmonary disease, pulmonary embolus, thrombophilia
Describe the possible techniques for liposuction.
dry technique
wet technique
super wet technique
tumescent method
Describe the dry technique for liposuction.
aspiration cannula inserted into space where fat will be removed
EBL 20-45% of aspirated volume
not recommended
Describe the wet technique for liposuction.
200-300 mL of solution injected into each area to be treated
EBL 4-30% of volume aspirated
Describe the super wet technique.
Infiltrated solution= amount of fat to be removed (1:1 ratio)
EBL 1% of volume aspirated
Describe the tumescent method.
large amount of solution (3-4 mL per mL of expected aspirate) injected into fatty tissue
EBL 1% of aspirated volume
The Tumescent solution is the
removal of SQ fat under anesthesia** infiltrated with large volumes of saline solution with epinephrine & lidocaine
-definition excludes the use of another type of anesthesia
Describe the composition of Klein’s solution:
50 mL of 1% lidocaine + 1 mL 1:1000 epinephrine + 12.5 mL 8.4% NaH2Co2+ 1000 NS****
The lidocaine max according to the FDA is
35 mg/kg of total body weight
total adrenaline max 50 mcg/kg
The Hunstead solution is
another form of tumescent solution
1000 LR + 50 mL of 1% lidocaine + 1 mL 1:1000 epinephrine
no burning sensation with LR (sodium load is also reduced)
The bicarb within Tumescent solution works to
increase the pH, quicken the onset, and help reduce pain
The complications of liposuction include
LAST hypothermia fat embolism/DVT/PE acute anemia pulmonary edema fluid overload electrolyte imbalances death
Describe the lidocaine max dosing.
dermatology/plastic surgery says 55 mg/kg of weight
anesthesiology says 5 mg/kg of weight
lido w/ epi max dose is 500 mg
Epinephrine 1:200,000 reduces absorption of SQ lidocaine by 50%
With liposuction, the total volume of fat removal
should be <5 L in single session or not to exceed 5% of body weight
When removing higher volumes with liposuction, it can lead to
hypovolemia, bleeding, & electrolyte disturbances
Describe the IVF management for liposuction.
for < 4 L= maintenance only
for >4 L= maintenance + 0.25 mL/mL removed after 4L
Goal: maintain normal intravascular volume with postanesthetic Hct >30% and albumin >3 g
The anesthetic considerations for liposuction include
GA+ SCDs
if large volume lipo, need foley, bair hugger, fluid warmer
incision sites are closed with sterile dressings
compression garment
pain related to amount of fat removed
tissue trauma from suctioning
Complications of liposuction include
PE, fat embolus, fluid overload, LAST, epinephrine toxicity, hemorrhage, nerve damage
Describe the fluid status with liposuction.
60% of solution infused remains in tissues
third spacing into surgical cavities
over/under estimation of fluid shifts can lead to pulmonary edema or hypovolemic shock**
360 degree liposuction is
liposuction of the entire truncal midsection
Goal is to complete curvier contour from every angle
can be combined with dermolipectomy, plication of the rectus abdominis muscle, umbilicoplasty, or gluteal fat grafting
Abdominoplasty is the
surgery of the abdominal wall- umbilicus circumcised and blood supply preserved
resection of skin excess (pubis to costal margin)
can be combined with liposuction or plication of the rectus abdominis muscle
Abdominoplasty positioning is the
semi-fowler position
Abdominoplasty is common in patients who have had
multiple pregnancies, or those who lost a lot of weight or after bariatric procedures
Anesthetic considerations for abdominoplasty include
2-5 hour procedure length
post gastric bypass, ensure patients have stable weight for six months prior to surgery with stable health status
labs: CBC, CMP, EKG, liver function
GA
overnight monitoring if comorbidities & extent of surgery
fluid warmer, bair hugger, foley, PIV, abx
Describe emergence & postop considerations for abdominoplasty.
NEED TO FLEX TABLE FOR CLOSURE*** to reduce tension on suture lines
emergence: smooth emergence, antiemetics, binder placement, semi-fowler
PCA +/- epidural for postoperative pain management
Complications of abdominoplasty include:
ileus, infection, dehiscence, fat embolus, DVT
The goal of the mommy makeover is to
restore shape and appearance after childbearing
