Can Lidocaine poisoning occur with Vaser Liposuction under full anesthesia?

Lidocaine toxicity can happen regardless of local vs general anesthesia. Adrenaline (epinephrine) causes blood vessels to temporarily shrink in size and makes the lidocaine stick around a bit longer and can allow for a larger safe dose. Make sure to research your provider to make sure they are fully trained in plastic surgery. These providers will be aware of amounts of medications used to keep you safe.

Thank you for your question. This is a very important question. It is not the type of liposuction technique that causes lidocaine poisoning, it is the miscalculation of the dosage of lidocaine (mg/kg) that is given to the patient. Not to get into too much dosing and pharmacology, most surgeons recommend 35 mg/kg lidocaine with epinephrine ( 50 cc lidocaine 1% with Epinephrine 1:100,000= 500 mg lidocaine and epinephrine 1:100,000). This dilutes the epinephrine to 1:1,000,000 in a one liter saline solution or lactated ringer's solution. I've seen some surgeons and dermatologists who use only local tumescent anesthesia go as high as 90 mg/kg body weight! You can achieve toxic intravascular levels with these formulations, but the danger is that the coma and fatal outcome will not happen until 6-8 hours later when the patient is already home.

Personally, I use IV sedation for my VASER Hi Def Lipo technique with 1% lidocaine and 1:100,000 epinephrine at 25 mg/kg body weight. Some people use less or under general anesthesia they just use epinephrine solution. I like that with some lidocaine in the tissues, the patient has less discomfort early postop.

See a board certified plastic surgeon experienced in advanced body sculpting techniques for an in person consultation/evaluation. Good luck.

What you are referring to is lidocaine toxicity as a result of tumescent anesthesia. The short answer is yes. But, let's review.
Before any lipo procedure (VASER, traditional, awake, etc), we utilize a fluid mixture of IV fluids, local anesthetic (lidocaine), plus other additives (I personally have a proprietary blend that helps reduce inflammation). This fluid mixture is called tumescent, and is infiltrated in all of the proposed areas of lipo. What this fluid does is engorge the fat cells (to make them easier for extraction), minimize bleeding (through vasoconstriction from the epinephrine - or adrenaline) , minimize pain (via lidocaine) and in the context of VASER, minimize the risk of thermal injury (or burns) to the superficial skin.
Now, with general anesthesia, the requirements for lidocaine (and epinephrine) are less, and may reduce your risk slightly.
All surgeons should calculate the maximum lidocaine that my be administered, and stay well below the limit.
-Dr. Satey

Hello david
theoretically YES , with any type of liposuction if xylocaine or lignocaine is used over the above recommended dose then lidocaine toxicity can develop which can have varied risk and complications . so the doctor with whom you have chosen your procedure must be trained and professional enough to take care of this . all qualified doctors follow the recommended dose and during liposuction procedure they use the calculated dose and keeping the safe level plus if your doctor is trained in vaser liposuction i am sure he/she can take care of this whether the procedure is done in general or local anesthesia . there are lot of varied factors which surgeon will take in account like multiple body parts, duration of the procedure , amount of fat to be taken out etc which all depends on your body profile second thing you asked about adrenaline . yes it is used in the recommended dosage for infiltration solution which is a key and first step of liposuction . when general anesthesia is used the lidocaine can be used in less quantity as pain during the procedure is taken by general anesthesia medication. so your operating surgeon will take care of this
the complications if performed by qualified doctor and trained in liposuction is rare and particualry lignocaine and adrenaline toxicity is very rare
so do not get fearful about this . these are rarest of rare complications
hope it will be useful to you and discuss with your surgeon again to make you calm and relax properly

The number of fatalities related to lidocaine toxicity are actually very very few.

Of the different causes of fatal outcomes from Liposuction procedures lidocaine toxicity tends to be towards the bottom.

When you include fat transfer, fat embolism quickly rises to the number one position with the BBL procedure with surgeons grafting fat into the gluteus muscle accidentally injecting fat into the gluteal vein.

After this delayed diagnosis followed by delayed intervention of intra abdominal or intrathoracic injuries and or infections is the next highest reason for fatal outcomes.

We have excellent data on safety and lidocaine dosing.

Many of these studies have been repeated showing that large amounts of lidocaine can safely be used in conjunction with epinephrine When injected as tumescent solution in fat for liposuction.

Personally I believe those few cases of lidocaine toxicity leading to fatal outcomes were directly related to dosing errors. I am not privy to the information so this is just an educated guess.

The other explanation is patients who take medications competing with the P450 enzyme system in the liver slowing down the breakdown of lidocaine. Experienced and thorough plastic surgeons should recognize this during the consultation when reviewing patient’s medications.

If patients don’t disclose all the medications they’re taking or surgeons are inexperienced or unaware of these competitive properties lidocaine toxicity is more likely to happen. Even then it’s extremely rare.

Personally I think the cases you refer to were due to people being careless or allowing untrained staff to mix the numbing solution without supervision.

For example lidocaine comes in many different strengths including 1/2%, 1% and 2%.

Sometimes supply companies may have a shortage on one concentration and a clinic may order a different concentration.

If a nurse is used to mixing tumescent solution by always placing a certain amount of lidocaine in each bag but this time the concentration is four times higher you can see why something could go wrong.

These type of errors are simply human errors and that same error could happen with an anesthesiologist using anesthetic drugs or many other things.

Medicine is not full proof to human error though we have many safeguards in place.

Most surgeons doing Liposuction under general anesthesia use much less tumescent solution then surgeons doing awake surgery.

For general anesthesia we don’t need any lidocaine and could simply inject dilute epinephrine alone.

The lidocaine does serve a purpose to keep the patient more comfortable when waking up and during recovery.

Epinephrine typically has not been the cause of fatal outcomes that I know of but it certainly could.

My practice has been devoted exclusively to Liposuction and fat transfers only for the last decade.

I have performed over 7000 Liposuction procedures.

I do all my liposuction and fat transfer procedures with patients awake as office procedures using local anesthesia with mild sedation.

I’ve been doing liposuction and fat transfer this way for over a decade.

I’ve had one patient who called me after surgery thinking he had blurred vision because he had been reading about lidocaine toxicity the night before surgery.

Of 7000 cases this is the only time I’ve had anyone even potentially show symptoms of lidocaine toxicity other than being comfortable(High doses of lidocaine given as tumescent solution significantly reduces postoperative pain during the first 24 hours)

As an anesthesiology friend of mine said” There’s a long distance between having lidocaine toxicity symptoms and dying“

Personally I believe awake Liposuction is safer than Liposuction under general anesthesia.

While general anesthesia is pretty darn safe it does have its own set of a rare bad outcomes.

In regards to safety I believe one of the benefits of keeping patients awake is that if the surgeon accidentally penetrates the chest or abdomen with a patient awake they will immediately let you know something is wrong.

Should that happen an attentive plastic surgeon would then follow that patient very closely looking for signs or symptoms of intrathoracic or intra-abdominal injuries.

This might include seeing the patient on a more frequent interval, getting chest x-rays, CT scans or blood tests for example.

Early intervention and early detection of intra abdominal or intrathoracic injuries is the key to minimizing the fatal comes after liposuction procedures.

If contemplating having Liposuction with a plastic surgeon doing this as an awake procedure you may want to discuss their view and dosing of lidocaine during the consultation.

Personally unless there’s a contraindication I’m comfortable using up to 50 mg of lidocaine per kilogram in tumescent solution during liposuction procedures.

This is typically more than enough to liposuction someone’s entire body.

To treat a typical full torso including upper abdomen, lower abdomen, love handles, waist, full back and under arm area+- chest, I usually use 30 mg of lidocaine per kilogram or less.

We calculate the safe amount of lidocaine to be used before every case and follow the amount injected carefully at all times. I personally always mix my own Tumescent solution.

When comparing risks it always needs to be done in correlation with incidence.

A single case that spread to the media can go viral while other cases that are settled outside of court are often legally bound to be kept secret.

Patients have no accurate source to know the number of patients who die from cosmetic surgery or what the incidences are.

The information is not available.

The American society of plastic surgeons gathers information the best they can and have published information for both surgeons and patients when and if necessary.

In the end the chance of you having lidocaine toxicity or some horrendous complication leading to a fatal or near fatal outcome is extremely unlikely.

The chance of you being dissatisfied with the outcome of the procedure or being left with some disfigurement on the other hand is much much more likely.

I suggest you put all your efforts exclusively on finding the most talented and experienced plastic surgeon in your area. To do that I suggest scheduling multiple in person consultations. Confirm the surgeons skill and experience by asking them to show you all of their before and after pictures for male chest and abdomen liposuction cases. And experienced plastic surgeon should have no problem showing you 20 sets of before and after pictures of male torso Liposuction results. A very experienced plastic surgeon should have 50 to 100 sets of before and after pictures. As a patient your goal should not be to simply see the best outcome of the surgeons career but to get an idea of what average results look like. Confirm the surgeons reputation by reading all the reviews on various physician review websites paying close attention to justified negative reviews. When I look at the best plastic surgeons I know they consistently have no to very few justified negative reviews on any of the review websites. I also find that unmanipulated organic reviews can to fall equally among the various review websites. Businesses with excessive numbers of reviews on a single review website shows evidence of review manipulation.

In my opinion this is the best way to select the most talented and experienced plastic surgeon in your area.

This will, if you forgive my expression, “kill two birds with one stone”.

In the hands of the most talented and experienced plastic surgeons you will also be safer.

From the patient’s perspective I think you should be more worried about the aesthetic outcome then having some horrendous complication.

In the end Liposuction is an extremely safe procedure.

If you’re comfortable driving on the freeway then you should be comfortable having Liposuction with her awake or under general anesthesia

Best,

Mats Hagstrom, MD