DOES
LIPOSUCTION REQUIRE AN IV?
Ó
PJWMDPA
Some authorities, including
Dr. Jeffrey Klein (at a December 1998 surgical conference), have stated
that it is not appropriate to insert an IV into someone who is undergoing
liposuction with the tumescent
method. The Web site author was present at
that meeting and questioned Dr. Klein as to his comment. Dr. Klein then
reversed his comments and agreed with the Web site author that an IV
may be useful during tumescent liposuction procedures. In fact the Florida
Board of Medicine, whom the Web site author has addressed during formal
sessions regarding the safety of office cosmetic surgery has recently
made the IV or IV access a requirement.
What are the Web site author's
reasons for supporting the use of an IV during liposuction? They are the
following: If this is the first time that the patient will ever undergo tumescent
liposuction, then this may be the first time the patient is exposed to the
preservative called methylparaben. Methylparaben is the preservative present
in the lidocaine numbing solution that is added to make the Klein solution
that is used to perform tumescent liposuction.
In Southern California,
several people developed immediate, instant, life-threatening allergic
reactions to the methylparaben. The reaction caused these patients to
be unable to breathe and caused the heart rate to rapidly accelerate.
Unfortunately, these patients did not have any IV access at that time.
If they had, the doctor performing the liposuction or an assistant could
have rapidly administered the proper emergency drugs into the patients'
bloodstreams to save their lives. Therefore, these patients died unnecessarily.
IV access (port) isn't just a tool designed to force doctors to do more
work during liposuction. An IV can be placed without the initiation
of the flow of the IV. By placing a small amount of a natural ingredient—heparin—in
the IV access, the access can be maintained without a flowing IV fluid.
This "heparin lock" can be in place just in case of emergency, should
the patient rapidly need some pain medication or another treatment.
The Web site author believes that many doctors do not use IV access
because these doctors are not experienced in placing IV access in a
manner that is virtually painless for the patient.
Why else should we want
an IV access? As is stated in the Glossary
under the term "straight/original tumescent method," stinging is involved
when the original tumescent solution is placed into the patient. Different
patients have different nervous system sensitivities. Different patients
have different thresholds for pain. If you are a person with a low threshold
of pain and you have not undergone liposuction before, you may not be
aware of how much stinging could be involved in the placement of the
tumescent solution.
With tumescent anesthesia
alone, you may experience significant pain, which, in turn, becomes
more significant pain (sort of a vicious cycle). This may cause other
problems. The heart rate may increase and blood may pump around faster,
thereby reducing the length and strength of the tumescent anesthesia,
which will not work as well. Higher blood pressure and greater heart
pumping may also mean more bleeding during and following liposuction.
With the IV comes the ability to sedate or anesthetize a patient in
a more complete fashion. An IV is very important in terms of aiding
in the outcome of the patient who has become extremely excited or nervous.
With an IV, rapid onset sedation is always easily available or can be
carried out in advance. It should be no problem to relax a patient with
the proper medicine if the patient were to become excited or nervous.
Skilled anesthesiologists
or CRNA's
(certified registered nurse anesthetists) can easily handle that situation.
If a patient opts to have straight liposuction alone, without ever having
an anesthesiologist or CRNA and without having had a similar procedure
before, he/she limits his/her options.
What if, for example, a 45-year-old
man wanted to have liposuction on his love handles and he has a blockage
in a coronary artery, a blockage that his cardiologist cannot hear with his
stethoscope and that he has not had a stress test or other scan to diagnose?
What if the patient gets excited or nervous or feels pain? What if he happens
to have a heart attack on the operating table? This situation could be much
more easily managed if an IV access was placed before the surgery. After
all, if someone is having a heart attack, usually the blood vessels collapse
and it is hard to find a vein in which to insert an IV. For every one minute
that a person's heart is not pumping, there is a 10% chance of brain death.
At the end of ten minutes, of course (ten times 10%, or 100%), there is no
chance of reviving a patient. Again, we must conclude that an IV is
important.
It is because of these
unforeseen, rare events that doctors are obliged to maintain the highest
standards of care. Some doctors will contend that the highest standards
of care are not necessary for every patient or situation. But this comment
is based upon odds of problems and calculated risks. Unfortunately,
calculated risks may end up as statistics. But how do some doctors know
exactly which patients or situations require a looser standard (for
example, doing an entire tumescent liposuction without an IV)? The author
believes that each and every patient is important and that the highest
standards of care must always be maintained, because a doctor can never
tell when a person with a potential problem has walked into his/her
office. The difference between good and bad doctors may largely be due
to the ability of a good doctor to recognize almost all potential problems
and to head them off (as opposed to a bad doctor, who may, in all honesty,
just not recognize the problem and who may unknowingly place the patient
in danger). A good doctor is usually a pessimist not an optimist when
it comes to taking or ignoring risks.
In summary, an IV is
a very simple and effective way to enhance the quality of care for all
patients undergoing liposuction surgery. There are very few instances
in which the Web site author does not offer an IV to a liposuction patient.
This exception would be in the rare instance that the author is removing
a lipoma or fat tumor in a very small area in a patient who has previously
had anesthetic containing methylparaben and who has not had any bad
reaction. The author may also tumesce (without an IV) during small secondary
procedures (any liposuction done for a second time in a single area).
In those rare patients (of the Web site author) who would only like
a small area treated, the author will place tumescent solution in the
area (without an IV), which usually provides for very little discomfort
at all. Otherwise, an IV is always recommended for safety.
