Intraoperative Cardiac Arrest During Liposuction: A Case Report

Overview

Journal Plast Reconstr Surg Glob Open

Specialty General Surgery

Date 2024 Mar 11

PMID 38463704

Authors

Lu Shu

Jian Zhou

Xue He

Affiliations

Soon will be listed here.

Abstract

Background: With the popularity of liposuction surgery, more awareness should be obtained regarding complications. Liposuction has been thought of as a safe procedure with a very low incidence of major complications. However, life-threatening risks of liposuction have rarely been reported.

Methods: We present a case of a 36-year-old woman who developed cardiac arrest during a liposuction procedure, and we present a literature review.

Results: She was previously healthy and had no risk factors for pulmonary embolism. The diagnosis was made based on clinical presentation and the presence of an electrolyte disorder and a positive sign on computed tomography pulmonary angiogram (CTPA). Mild hypothermia treatment, symptomatic treatment, and supportive therapy were applied. As the respiratory and circulation were smooth, she was discharged to a rehabilitation hospital. Seven months after discharge, the patient was still in a coma with eye opening.

Conclusions: Spinal anesthesia, pulmonary embolism, and hyperkalemia are the most probable contributors to the cardiac arrest observed during the liposuction procedure in this specific case. There is a heightened imperative to vigilantly monitor for critical incidents during these operations and to meticulously identify associated risk factors during liposuction.

References

Byeon S, Ban T, Rhee C . A Case of Acute Fulminant Fat Embolism Syndrome after Liposuction Surgery. Tuberc Respir Dis (Seoul). 2015; 78(4):423-7. PMC: 4620344. DOI: 10.4046/trd.2015.78.4.423. View

Kaoutzanis C, Gupta V, Winocour J, Layliev J, Ramirez R, Grotting J . Cosmetic Liposuction: Preoperative Risk Factors, Major Complication Rates, and Safety of Combined Procedures. Aesthet Surg J. 2017; 37(6):680-694. DOI: 10.1093/asj/sjw243. View

Shaikh N, Hanssens Y, Kettern M, Deleu D, Ruiz-Miyares F, Mesraoua B . [Cerebral fat embolism as a rare complication of liposuction with abdominoplasty]. Rev Neurol. 2008; 47(5):277-8. View

Thorsteinsson B, GLIEMANN J, Vinten J . The content of water and potassium in fat cells. Biochim Biophys Acta. 1976; 428(1):223-7. DOI: 10.1016/0304-4165(76)90122-7. View

Pinheiro L, Carmona B, Fascio M, de Souza I, de Azevedo R, Barbosa F . [Cardiac arrest after epidural anesthesia for a esthetic plastic surgery: a case report]. Rev Bras Anestesiol. 2016; 67(5):544-547. DOI: 10.1016/j.bjan.2015.03.006. View

Zeidman M, Durand P, Kundu N, Doumit G . Fat embolism after liposuction in Klippel-Trenaunay syndrome. J Craniofac Surg. 2013; 24(4):1319-21. DOI: 10.1097/SCS.0b013e3182953a63. View

Eriksson E, Pellegrini D, VanderKolk W, Minshall C, Fakhry S, Cohle S . Incidence of pulmonary fat embolism at autopsy: an undiagnosed epidemic. J Trauma. 2011; 71(2):312-5. DOI: 10.1097/TA.0b013e3182208280. View

Beidas O, Gusenoff J . Update on Liposuction: What All Plastic Surgeons Should Know. Plast Reconstr Surg. 2021; 147(4):658e-668e. DOI: 10.1097/PRS.0000000000007419. View

George J, George R, Dixit R, Gupta R, Gupta N . Fat embolism syndrome. Lung India. 2013; 30(1):47-53. PMC: 3644833. DOI: 10.4103/0970-2113.106133. View

10.

Konstantinides S, Meyer G . The 2019 ESC Guidelines on the Diagnosis and Management of Acute Pulmonary Embolism. Eur Heart J. 2019; 40(42):3453-3455. DOI: 10.1093/eurheartj/ehz726. View

11.

Duran H, Cardenas-Camarena L, Bayter-Marin J, Ramos-Gallardo G, Robles-Cervantes J . Microscopic and Macroscopic Fat Embolism: Solving the Puzzle with Case Reports. Plast Reconstr Surg. 2018; 142(4):569e-577e. DOI: 10.1097/PRS.0000000000004810. View

12.

Forget P, Borovac J, Thackeray E, Pace N . Transient neurological symptoms (TNS) following spinal anaesthesia with lidocaine versus other local anaesthetics in adult surgical patients: a network meta-analysis. Cochrane Database Syst Rev. 2019; 12:CD003006. PMC: 6885375. DOI: 10.1002/14651858.CD003006.pub4. View

13.

Caplan R, Ward R, Posner K, Cheney F . Unexpected cardiac arrest during spinal anesthesia: a closed claims analysis of predisposing factors. Anesthesiology. 1988; 68(1):5-11. DOI: 10.1097/00000542-198801000-00003. View

14.

Kuan K, Rahalkar K . Beyond 5Hs and 5Ts: a rare cause of cardiac arrest. Singapore Med J. 2021; 64(2):146-148. PMC: 10071844. DOI: 10.11622/smedj.2021120. View

15.

Diniz D, Goncalves K, Silva C, Araujo E, Carneiro S, Lago C . Complications associated with submental liposuction: a scoping review. Med Oral Patol Oral Cir Bucal. 2022; 27(3):e257-e264. PMC: 9054168. DOI: 10.4317/medoral.25122. View

16.

Anderson D, Morgano G, Bennett C, Dentali F, Francis C, Garcia D . American Society of Hematology 2019 guidelines for management of venous thromboembolism: prevention of venous thromboembolism in surgical hospitalized patients. Blood Adv. 2019; 3(23):3898-3944. PMC: 6963238. DOI: 10.1182/bloodadvances.2019000975. View

17.

Sood J, Jayaraman L, Sethi N . Liposuction: Anaesthesia challenges. Indian J Anaesth. 2011; 55(3):220-7. PMC: 3141144. DOI: 10.4103/0019-5049.82652. View

18.

Cardenas-Camarena L, Duran H, Robles-Cervantes J, Bayter-Marin J . Critical Differences between Microscopic (MIFE) and Macroscopic (MAFE) Fat Embolism during Liposuction and Gluteal Lipoinjection. Plast Reconstr Surg. 2017; 141(4):880-890. DOI: 10.1097/PRS.0000000000004219. View

19.

de Lima E Souza R, Apgaua B, Milhomens J, Albuquerque F, Carneiro L, Mendes M . [Severe fat embolism in perioperative abdominal liposuction and fat grafting]. Rev Bras Anestesiol. 2015; 66(3):324-8. DOI: 10.1016/j.bjan.2013.11.006. View

20.

Erba P, Farhadi J, Schaefer D, Pierer G . Fat embolism syndrome after combined aesthetic surgery. J Plast Surg Hand Surg. 2010; 45(1):51-3. DOI: 10.3109/02844310801956623. View