Anaesthetic challenges for a Vaser liposuction surgery
In a Vaser liposuction surgery the anaesthetics plays a vital role, that to prepare the treatable area to be numb and also allow vasoconstriction to control blood loss and bruising.
The basic idea of any liposuction and not just Vaser and Vaser hi def lipo is that a certain volume of a solution comprised of local anaesthetics and adrenalin is injected into the fat layers before performing the surgery.
The volume of the anaesthetic solution might be large that is an approx, 35-55mg/kg which might raise concerns of toxicity, which is best determined by an anesthesiologist as the exact volume of the anaesthetic and according with the amount of fat to be drained out of the body. For a large session of Vaser liposuction, up to 4,000 ml of fat can be aspirated, now this fat can be drained out of the body with low volume of anaesthetic, or high volume of anaesthetic.
Tumescent technique is the most widely used and is also the traditional technique. Tumescent, meaning to swell is exactly what has been purposed for performing a Vaser liposuction surgery. In the way, a large volume of the tumescent anaesthetic solution that is almost equal to the fat to be aspirated out is injected to the skin which soon results in swelling up the area and also makes it hard, firm and turgid, this causes less blood loss as the fat cells are poked and melted down with a ultrasound vibrations through the Vaser probes; and while it is aspirated out of the body less blood to go with it.
The tumescent anaesthetic solution is comprised of local anaesthesia and additives of sodium bicarbonate and epinephrine. This accommodates less blood loss creating a strong surface of the skin and the fat cells are broken and melted down and drained out. For larger sessions of Vaser Liposuction, intravenous injections of saline solutions might be added to further minimise total blood loss and avoid complications with larger volumes of fluid aspirated out of the body.
The wetting solution for Vaser Liposuction means the volume of the injected solution and has further subcategories, based on their usage and dilution of agents:
· Crystalloid solutions
0.9% isotonic saline or lactated Ringer’s solution and local anaesthetic is to together diluted to create this tumescent anaesthetic solution that is to injected both subcutaneously and intravenously in larger volumes. While isotonic saline causes burning sensation as it is injected, the lactated Ringer's solution is chosen for it causes no burning sensation
· Local anaesthetics for Vaser Liposuction
Lignocaine happens to be the widely used local anaesthesia for the tumescent solution. A solution of Lignocaine mixed with adrenaline agents as 7mg/kg was considered as the maximum dosage. However, with tumescent technique, the volume of the lignocaine mixed with a tumescent solution may be significantly larger as 35-55mg/kg depending on the amount of fat to be removed is permissible.
Vascularity, meaning how much dense blood vessels, nerves and collagen are there in a treatable area, the amount of the concentration of lignocaine in the tumescent solution also varies. Areas such as breasts and abdomen are vascular areas that can be injected up tp 1,500 mg/l of normal saline, whereas in areas that less vascular such as thighs and flanks, the concentration of lignocane can be reduced to 500 mg/L of normal saline.
Toxicity from local anaesthetics is studied and kept under control by assessing the how the lignocaine dissolves in the blood. Toxicity from local anaesthetics is identified by its peak lignocaine plasma level and the rate of systematic absorption of the concentration to blood based on an mg per kg dosage.
The function of a vasoconstrictor is to constrict vascularity and thus also delaying the blood vessels from absorbing local anaesthetics. Vasoconstrictors are purposed by adrenaline agents mixed to the tumescent solution in an ideal concentration of 0.25-1 mg/L depending on the tissue vascularity. The concentration of the vasoconstrictor can be increased and decreased depending on the vascularity of the treatable area. The dose should not exceed 50μg/kg. If the maximum dose is anticipated to exceed, the procedure should be done in several stages. l-ornithine 8-vasopressin and epinephrine are the most widely used adrenalin agents.
There is often a burning sensation felt by patients as soon the tumescent solution is injected, hence, sodium bicarbonate is used to reduce the burning sensation.
Steroids are used as anti-inflammatory agents to be added to the tumescent solution and moreover have the properties of stabilizing the circulatory system
Vaser Liposuction is a popular procedure for body contouring and removing excessive body fat from various problem areas in the body. There might also be criterions of hemodynamic changes in the physiology of it and the more complications arise with larger volumes of fat reduction. The anesthesiologists are required to be well experienced and highly educated to be trusted with a Vaser or Vaser hi def liposuction. With proper guidance of monitoring the hemodynamic changes and drug reactions of patients and with properly cared intra-operative fluid administration, a Vaser Liposuction is regarded to be safe and ensures a good outcome.