Lidocaine Use and Toxicity in Cosmetic Surgery

doi:10.1017/CBO9780511547218.011

8 - Lidocaine Use and Toxicity in Cosmetic Surgery

from PART I - MINIMALLY INVASIVE ANESTHESIA (MIA)Ⓡ FOR MINIMALLY INVASIVE SURGERY

Published online by Cambridge University Press: 22 August 2009

Adam Frederic Dorin M.D., M.B.A.

Edited by

Barry Friedberg

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Adam Frederic Dorin M.D., M.B.A.: Affiliation:
Medical Director Grossmont Plaza Surgery Center, San Diego, CA
Barry Friedberg: Affiliation:
Keck School of Medicine, University of Southern California

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Summary

INTRODUCTION AND OVERVIEW

The use and toxicity of lidocaine in modern cosmetic surgical practice is arguably the most important topic for any anesthesiologist or surgeon working in this field of medicine. Lidocaine toxicity, primarily in the context of suction assisted lipectomy (SAL), lipoplasty, or liposuction, has historically accounted for a significant proportion of patient morbidity and mortality.

This chapter covers lidocaine pharmacology, the history of lidocaine use in the context of cosmetic/plastic surgical practice, and the politics or practical concerns of pushing the envelope toward higher, “megadose” tumescent lidocaine solutions. As there are ample resources to address the basic structure of the lidocaine molecule, and multiple books and articles on the basic science and pharmacokinetics of lidocaine, no space is wasted in displaying this information. Similarly, the related subjects of peribulbar versus topical anesthesia in ophthalmic surgery and transient neurotoxic symptoms in lidocaine spinal anesthesia are not analyzed in this context.

BRIEF PHARMACOLOGY

Lidocaine, an amide molecule synthesized from cocaine, was first applied in the practice of medicine in 1948. As clinical applications and the advancement of medicine expanded the role of lidocaine, this drug found a niche applied topically and subcutaneously for local anesthesia for a variety of surgical procedures. Lidocaine is used intravenously to treat ventricular arrhythmias. Dilute solutions of lidocaine mixed with epinephrine are administered as tumescent solution for liposuction cosmetic surgery.

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Type: Chapter
Information: Anesthesia in Cosmetic Surgery , pp. 72 - 83

DOI: https://doi.org/10.1017/CBO9780511547218.011 [Opens in a new window]

Publisher: Cambridge University Press

Print publication year: 2007

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References

Goodman, Gillman : The Pharmacologic Basis of Therapeutics. 10th ed. New York, McGraw-Hill, 2001, pp. 374, 961.

Boyes, RN: The pharmacokinetics of lidocaine in man. Clin Pharmacol Ther 12:105, 1971.

Narand, PK: Lidocaine and its active metabolites. Clin Pharmacol Ther 24:654, 1978.

Melmon, HK: Clinical Pharmacology:Basic Principles in Therapeutics. 2nd ed. New York, Macmillan Ltd. 1978, p. 226.

Marriot, HJ: Lidocaine toxicity. J Electrocardiology 7:70, 1974.Google Scholar

Smith, M , Wolfram, W: Toxicity-seizures in an infant caused by (or related to) oral viscous lidocaine use. J Emerg Med 10:587, 1992.Google Scholar

Jonville, AP, Barbier, P: Accidental lidocaine overdose in an infant. J Toxicol Clinical Toxicol 28:101, 1990.Google Scholar

Lie, RL: Severe lidocaine intoxication by cutaneous absorption. J Am Acad Derm 5:1026, 1990.Google Scholar

Palmisano, JM: Lidocaine toxicity after subcutaneous infiltration in children undergoing cardiac catheterization. Am J Cardiol 67:647, 1991.Google Scholar

Coldiron, B, Shreve, BA, Balkrishnan, R, et al.: Patient injuries from surgical procedures performed in medical offices: Three years of Florida data. Dermatol Surg 30:1435, 2004.Google Scholar

Williford, P: Commentary on Coldiron, B, Shreve, E, Balkrishnan, R: Patient injuries from surgical procedures performed in medical offices: Three years of Florida data. Dermatol Surg 30:1443, 2004.Google Scholar

Gorney, M: Liability issues in aesthetic surgery. Aesth Surg J 2:226, 2000.Google Scholar

Grazer, FM, Jong, RH: Fatal outcomes from liposuction: Census survey of cosmetic surgeons. Plast Reconstr Surg 105:436, 2000.Google Scholar

Rao, RB, Ely, SF: Deaths related to liposuction. N Engl J Med 340:1471, 1999.Google Scholar

Lofsky, AS: Deep venous thrombosis and pulmonary embolism in plastic surgery office procedures. The Doctors' Company Newsletter, Napa, CA, 2005. www.thedoctors.com/risk/specialty/anesthesiology/J4254.aspGoogle Scholar

Lillis, PJ: Liposuction under local anesthesia: Limited blood loss and minimal lidocaine absorption. J Dermatol Oncol Surg 14:1145, 1988.Google Scholar

Hildreth B: Large Volume Liposuction. Presented at the World Congress of Liposuction, Pasadena, CA, October 9–11, 1998.

Friedberg BL: Propofol ketamine anesthesia for cosmetic surgery in the office suite, chapter in Osborn, I (ed.), Anesthesia for Outside the Operating Room. International Anesthesiology Clinics. Baltimore, Lippincott, Williams & Wilkins 41(3):47, 2003.

www.asds-net.org/liposafety (Am Soc for Dermatological Surgeons); www.plasticsurgery.org/mediactr/natstats (Am Soc of Plastic Surgeons).

Cosmetic Surgery National Data Bank 2003 Statistics. New York, NY. Am Soc for Aesthetic Plastic Surgery, 2004.

Klein, JA: The tumescent technique for liposuction surgery. Am J Cosmet Surg 4:263, 1987.Google Scholar

Klein, JA: Tumescent technique for regional anesthesia permits lidocaine doses of 35 mg/kg for liposuction. J Dermatol Surg Oncol 16:248, 1990.Google Scholar

Fodor, PB: Defining wetting solutions in lipoplasty. Plast Reconstr Surg 103:1519, 1999.Google Scholar

Ostad, A, Kageyama, N: Tumescent anesthesia with a lidocaine dose of 55 mg/kg is safe for liposuction. Dermatol Surg 22:921, 1996.Google Scholar

Laurito CE: Anesthesia provided at alternative sites, in Barasch, PG, Cullen, BF, Stoelting, RK (eds.), Clincal Anesthesia, 4th ed., Philadelphia, Lippincott, Williams & Wilkins, 2001, p. 1343.

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