Hemodynamic physiology and thermoregulation in liposuction

Jeffrey M. Kenkel, Avron H. Lipschitz, Maureen Luby, Ian Kallmeyer, Evan Sorokin, Eric Appelt, Rod J. Rohrich, Spencer A. Brown

Research output: Contribution to journalArticle

47 Citations (Scopus)

Abstract

Little is known about the physiology of large-volume liposuction. Patients are exposed to prolonged procedures, general anesthesia, fluid shifts, and infusion of high doses of epinephrine and lidocaine. Consequently, the authors examined the thermoregulatory and cardiovascular responses to liposuction by assessing multiple physiologic factors. The aims of their study were to serially determine hemodynamic parameters perioperatively, to quantify perioperative and postoperative plasma epinephrine levels, and to chronologically document fluctuations in core body temperature. Five female volunteers with American Society of Anesthesiologists' physical status I and II underwent moderate- to large-volume liposuction. Heart rate, blood pressure, mean pulmonary arterial pressure, cardiac index, and central venous pressure were monitored. Serum epinephrine levels and core body temperature were assessed perioperatively. The hemodynamic responses to liposuction were characterized by an increase in cardiac index (57 percent), heart rate (47 percent), and mean pulmonary arterial pressure (44 percent) (p < 0.05). Central venous pressure was not significantly altered. Maximum epinephrine levels were observed 5 to 6 hours after induction. Significant correlations between cardiac index and epinephrine concentrations were shown intraoperatively (r = 0.75). All patients developed intraoperative low body temperatures (mean 35.5°C). An overall enhanced cardiac function was observed in patients subsequent to large-volume liposuction. The etiology of the altered cardiac parameters was multifactorial but may have been attributable in part to the administration of epinephrine, which counters the effects of general anesthesia and operative hypothermia. Additional explanations for raised cardiac output may be hemodilution or emergence from general anesthesia. Elevated mean pulmonary arterial pressure may be a result of subclinical fat embolism demonstrated in previous porcine studies, although fat was not observed in urine. The unchanged central venous pressure levels indicate that young healthy patients with compliant right ventricles can accommodate the fluid loads of large-volume liposuction. Overall hemodynamic parameters remained within safe limits. Within these surgical parameters, patients should be clinically screened for cardiovascular and blood pressure disorders before liposuction is undertaken, and preventative measures should be taken to limit intraoperative hypothermia.

Original languageEnglish (US)
Pages (from-to)503-513
Number of pages11
JournalPlastic and Reconstructive Surgery
Volume114
Issue number2
DOIs
StatePublished - Aug 2004

Fingerprint

Lipectomy
Body Temperature Regulation
Epinephrine
Hemodynamics
Central Venous Pressure
Body Temperature
General Anesthesia
Arterial Pressure
Hypothermia
Lung
Heart Rate
Fluid Shifts
Blood Pressure
Fat Embolism
Hemodilution
Lidocaine
Cardiac Output
Heart Ventricles
Volunteers
Swine

ASJC Scopus subject areas

  • Surgery

Cite this

Kenkel, J. M., Lipschitz, A. H., Luby, M., Kallmeyer, I., Sorokin, E., Appelt, E., ... Brown, S. A. (2004). Hemodynamic physiology and thermoregulation in liposuction. Plastic and Reconstructive Surgery, 114(2), 503-513. https://doi.org/10.1097/01.PRS.0000132676.19913.A3

Hemodynamic physiology and thermoregulation in liposuction. / Kenkel, Jeffrey M.; Lipschitz, Avron H.; Luby, Maureen; Kallmeyer, Ian; Sorokin, Evan; Appelt, Eric; Rohrich, Rod J.; Brown, Spencer A.

In: Plastic and Reconstructive Surgery, Vol. 114, No. 2, 08.2004, p. 503-513.

Research output: Contribution to journalArticle

Kenkel, JM, Lipschitz, AH, Luby, M, Kallmeyer, I, Sorokin, E, Appelt, E, Rohrich, RJ & Brown, SA 2004, 'Hemodynamic physiology and thermoregulation in liposuction', Plastic and Reconstructive Surgery, vol. 114, no. 2, pp. 503-513. https://doi.org/10.1097/01.PRS.0000132676.19913.A3
Kenkel, Jeffrey M. ; Lipschitz, Avron H. ; Luby, Maureen ; Kallmeyer, Ian ; Sorokin, Evan ; Appelt, Eric ; Rohrich, Rod J. ; Brown, Spencer A. / Hemodynamic physiology and thermoregulation in liposuction. In: Plastic and Reconstructive Surgery. 2004 ; Vol. 114, No. 2. pp. 503-513.
@article{1bde9e6c1f6743529f8ed29f0095f5af,
title = "Hemodynamic physiology and thermoregulation in liposuction",
abstract = "Little is known about the physiology of large-volume liposuction. Patients are exposed to prolonged procedures, general anesthesia, fluid shifts, and infusion of high doses of epinephrine and lidocaine. Consequently, the authors examined the thermoregulatory and cardiovascular responses to liposuction by assessing multiple physiologic factors. The aims of their study were to serially determine hemodynamic parameters perioperatively, to quantify perioperative and postoperative plasma epinephrine levels, and to chronologically document fluctuations in core body temperature. Five female volunteers with American Society of Anesthesiologists' physical status I and II underwent moderate- to large-volume liposuction. Heart rate, blood pressure, mean pulmonary arterial pressure, cardiac index, and central venous pressure were monitored. Serum epinephrine levels and core body temperature were assessed perioperatively. The hemodynamic responses to liposuction were characterized by an increase in cardiac index (57 percent), heart rate (47 percent), and mean pulmonary arterial pressure (44 percent) (p < 0.05). Central venous pressure was not significantly altered. Maximum epinephrine levels were observed 5 to 6 hours after induction. Significant correlations between cardiac index and epinephrine concentrations were shown intraoperatively (r = 0.75). All patients developed intraoperative low body temperatures (mean 35.5°C). An overall enhanced cardiac function was observed in patients subsequent to large-volume liposuction. The etiology of the altered cardiac parameters was multifactorial but may have been attributable in part to the administration of epinephrine, which counters the effects of general anesthesia and operative hypothermia. Additional explanations for raised cardiac output may be hemodilution or emergence from general anesthesia. Elevated mean pulmonary arterial pressure may be a result of subclinical fat embolism demonstrated in previous porcine studies, although fat was not observed in urine. The unchanged central venous pressure levels indicate that young healthy patients with compliant right ventricles can accommodate the fluid loads of large-volume liposuction. Overall hemodynamic parameters remained within safe limits. Within these surgical parameters, patients should be clinically screened for cardiovascular and blood pressure disorders before liposuction is undertaken, and preventative measures should be taken to limit intraoperative hypothermia.",
author = "Kenkel, {Jeffrey M.} and Lipschitz, {Avron H.} and Maureen Luby and Ian Kallmeyer and Evan Sorokin and Eric Appelt and Rohrich, {Rod J.} and Brown, {Spencer A.}",
year = "2004",
month = "8",
doi = "10.1097/01.PRS.0000132676.19913.A3",
language = "English (US)",
volume = "114",
pages = "503--513",
journal = "Plastic and Reconstructive Surgery",
issn = "0032-1052",
publisher = "Lippincott Williams and Wilkins",
number = "2",

}

TY - JOUR

T1 - Hemodynamic physiology and thermoregulation in liposuction

AU - Kenkel, Jeffrey M.

AU - Lipschitz, Avron H.

AU - Luby, Maureen

AU - Kallmeyer, Ian

AU - Sorokin, Evan

AU - Appelt, Eric

AU - Rohrich, Rod J.

AU - Brown, Spencer A.

PY - 2004/8

Y1 - 2004/8

N2 - Little is known about the physiology of large-volume liposuction. Patients are exposed to prolonged procedures, general anesthesia, fluid shifts, and infusion of high doses of epinephrine and lidocaine. Consequently, the authors examined the thermoregulatory and cardiovascular responses to liposuction by assessing multiple physiologic factors. The aims of their study were to serially determine hemodynamic parameters perioperatively, to quantify perioperative and postoperative plasma epinephrine levels, and to chronologically document fluctuations in core body temperature. Five female volunteers with American Society of Anesthesiologists' physical status I and II underwent moderate- to large-volume liposuction. Heart rate, blood pressure, mean pulmonary arterial pressure, cardiac index, and central venous pressure were monitored. Serum epinephrine levels and core body temperature were assessed perioperatively. The hemodynamic responses to liposuction were characterized by an increase in cardiac index (57 percent), heart rate (47 percent), and mean pulmonary arterial pressure (44 percent) (p < 0.05). Central venous pressure was not significantly altered. Maximum epinephrine levels were observed 5 to 6 hours after induction. Significant correlations between cardiac index and epinephrine concentrations were shown intraoperatively (r = 0.75). All patients developed intraoperative low body temperatures (mean 35.5°C). An overall enhanced cardiac function was observed in patients subsequent to large-volume liposuction. The etiology of the altered cardiac parameters was multifactorial but may have been attributable in part to the administration of epinephrine, which counters the effects of general anesthesia and operative hypothermia. Additional explanations for raised cardiac output may be hemodilution or emergence from general anesthesia. Elevated mean pulmonary arterial pressure may be a result of subclinical fat embolism demonstrated in previous porcine studies, although fat was not observed in urine. The unchanged central venous pressure levels indicate that young healthy patients with compliant right ventricles can accommodate the fluid loads of large-volume liposuction. Overall hemodynamic parameters remained within safe limits. Within these surgical parameters, patients should be clinically screened for cardiovascular and blood pressure disorders before liposuction is undertaken, and preventative measures should be taken to limit intraoperative hypothermia.

AB - Little is known about the physiology of large-volume liposuction. Patients are exposed to prolonged procedures, general anesthesia, fluid shifts, and infusion of high doses of epinephrine and lidocaine. Consequently, the authors examined the thermoregulatory and cardiovascular responses to liposuction by assessing multiple physiologic factors. The aims of their study were to serially determine hemodynamic parameters perioperatively, to quantify perioperative and postoperative plasma epinephrine levels, and to chronologically document fluctuations in core body temperature. Five female volunteers with American Society of Anesthesiologists' physical status I and II underwent moderate- to large-volume liposuction. Heart rate, blood pressure, mean pulmonary arterial pressure, cardiac index, and central venous pressure were monitored. Serum epinephrine levels and core body temperature were assessed perioperatively. The hemodynamic responses to liposuction were characterized by an increase in cardiac index (57 percent), heart rate (47 percent), and mean pulmonary arterial pressure (44 percent) (p < 0.05). Central venous pressure was not significantly altered. Maximum epinephrine levels were observed 5 to 6 hours after induction. Significant correlations between cardiac index and epinephrine concentrations were shown intraoperatively (r = 0.75). All patients developed intraoperative low body temperatures (mean 35.5°C). An overall enhanced cardiac function was observed in patients subsequent to large-volume liposuction. The etiology of the altered cardiac parameters was multifactorial but may have been attributable in part to the administration of epinephrine, which counters the effects of general anesthesia and operative hypothermia. Additional explanations for raised cardiac output may be hemodilution or emergence from general anesthesia. Elevated mean pulmonary arterial pressure may be a result of subclinical fat embolism demonstrated in previous porcine studies, although fat was not observed in urine. The unchanged central venous pressure levels indicate that young healthy patients with compliant right ventricles can accommodate the fluid loads of large-volume liposuction. Overall hemodynamic parameters remained within safe limits. Within these surgical parameters, patients should be clinically screened for cardiovascular and blood pressure disorders before liposuction is undertaken, and preventative measures should be taken to limit intraoperative hypothermia.

UR - http://www.scopus.com/inward/record.url?scp=4444323474&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=4444323474&partnerID=8YFLogxK

U2 - 10.1097/01.PRS.0000132676.19913.A3

DO - 10.1097/01.PRS.0000132676.19913.A3

M3 - Article

C2 - 15277823

AN - SCOPUS:4444323474

VL - 114

SP - 503

EP - 513

JO - Plastic and Reconstructive Surgery

JF - Plastic and Reconstructive Surgery

SN - 0032-1052

IS - 2

ER -