How long does tachycardia from liposuction Epinephrine last?

Question

I know there's a lot of epi used in lipo. I read that Epinephrene can peak in plasma 5 hours after. Will my heart be racing even after surgery?

Dana Goldberg, MD · Answer

While it's true that plasma levels of local anesthesia can peak several hours after surgery, this refers mostly to the lidocaine (or anesthesia portion). Epinephrine has a shorter half life (meaning it's broken down more quickly), so it's unusual to notice a significant heart rate change hours after surgery. Since the concentration is lower than traditional local anesthesia and it's injected into the fat (and not into the mouth) its effects are less than you'd notice at the dentist.

Semih Yildiz, MD, FEPOBRAS · Answer

Epinephrine is commonly added to tumescent liposuction fluid to reduce bleeding and bruising. Some of it can be absorbed into the bloodstream, and that can sometimes cause a faster heartbeat, shakiness, or a fluttery feeling. In most healthy patients, this is mild and temporary, and it is monitored during and after the procedure.

Because tumescent fluid is placed under the skin and absorbed gradually, the epinephrine effect can be delayed compared with a quick injection at the dentist. Even so, most patients should not have a dangerously racing heart after liposuction simply from the epinephrine when dosing is appropriate and monitoring is done properly.

A fast heart rate after surgery is not always from epinephrine. Pain, anxiety, dehydration, nausea medications, anemia, bleeding, thyroid issues, arrhythmia, or rarely a blood clot can also cause tachycardia. That is why persistent or significant tachycardia should be taken seriously rather than assumed to be normal.

Before surgery, tell your surgeon and anesthesia provider if you have palpitations, arrhythmia, high blood pressure, thyroid disease, panic attacks, stimulant use, or take medications that affect heart rate. After surgery, seek urgent care or call your surgical team immediately if your heart rate is persistently very high, irregular, or associated with chest pain, shortness of breath, fainting, severe dizziness, worsening weakness, or unusual bleeding. A brief mild increase can happen; ongoing or symptomatic racing should be evaluated.

Emmanuel De La Cruz, MD · Answer

Tachycardia (an abnormally fast heart rate) caused by epinephrine used during liposuction typically doesn't last very long. Here's a general timeline and factors that can influence the duration:

Duration:
Immediate Effect: The tachycardia usually begins shortly after the administration of epinephrine.
Short-Term: The effects of epinephrine generally wear off within minutes to a few hours, depending on the dose and individual patient factors.
Monitoring: Patients are often monitored during and after the procedure to ensure that any side effects, including tachycardia, are managed promptly.
Factors Influencing Duration:
Dosage: The amount of epinephrine used can impact how long its effects last. Higher doses might cause more prolonged effects.
Individual Sensitivity: Some patients may be more sensitive to epinephrine and experience longer-lasting effects.
Metabolism: The rate at which your body metabolizes and clears the drug can vary, affecting how long the tachycardia lasts.
Overall Health: Patients with certain medical conditions, especially those related to the cardiovascular system, might experience different durations and intensities of tachycardia.
Managing Tachycardia:
Medical Supervision: It's crucial to be under medical supervision during and after the procedure to monitor and manage any side effects.
Medication: If tachycardia persists or causes significant discomfort, medical professionals might administer medications to help slow the heart rate.
Hydration and Rest: Ensuring adequate hydration and rest can help your body recover more quickly.
When to Seek Help:
Persistent Tachycardia: If the fast heart rate continues for an extended period or is accompanied by symptoms like chest pain, shortness of breath, or dizziness, seek medical attention immediately.
Post-Operative Concerns: Always discuss any concerns or unusual symptoms with your healthcare provider after the procedure.
In general, while tachycardia from epinephrine used in liposuction is usually short-lived, it's important to be monitored by healthcare professionals to ensure your safety and address any complications promptly.

Andrew Ray, DO · Answer

With a regular epinephrine, this can be the case, however, because the epinephrine is combined with such a large volume of tumescent solution those kind of the side effects are minimal.

In surgery we do you want to be careful if you're having awake liposuction, as there is a much greater chance of having very high volumes of lidocaine during the procedure, this is because it is harder to maintain patient comfort when they are fully awake. High dose of lidocain can also cause tachycardia.

It is my opinion if you were going to have liposuction in multiple areas to have a general anesthesia to improve comfort, and to decrease the chance for lidocaine toxicity.

David Hansen, MD · Answer

Tumescent lipo is so safe and the amount of epi and lidocaine is so diluted that it is unusual to get any tachycardia during or after lipo. This is unlike the tachy you get at your dentist which is full strenght epi.

Camille Cash, MD · Answer

Epinephrine is often a component of the tumescent solution used during liposuction.  It's purpose is to help control bleeding during the procedure.  While it can raise your heart rate and blood pressure, you will be monitored for safety during and after the procedure by trained medical staff.  I encourage you to discuss your concerns with your surgeon.  it is important that you feel comfortable and confident as you prepare for surgery.

Connie Hiers, MD, FACS · Answer

Most who get tachycardia from epinephrine only experience it in the first 20 minutes, and then the rhythm settles down to normal. Epinephrine does not last 5 hours, but the Lidocaine might.

Mats Hagstrom, MD (license on probation) · Answer

You are correct and that we use very large doses of both lidocaine and epinephrine when we do liposuction especially if large areas are being treated and if the patient is awake for the procedure.
I personally use as much as 50 mg per kilogram of lidocaine.
Most people will use 1 mL of epinephrine in a concentration of one to 1000 per liter of numbing solution.
When injected in a dilute solution into the fat, the absorption is much slower than for example, injections at the dentist.
Symptoms from epinephrine are usually manifested by people having tremors or shaking, but we do not see noticeable tachycardia.
I’ve done over 8000 Liposuction procedures, including using large amounts of numbing solution and have never had a patient develop significant tachycardia.
It’s just not what happens from these drugs during these procedures.
Patients shake, they feel anxious, but they don’t get tachycardia, regardless of what you believe or have read.
If there is tachycardia, it is very slight and at most 10% of baseline.
This would the heart rate would go from 80 to 88, which is not enough for anyone to even notice.
For most patients, the side effects of epinephrine typically settle down after a couple of hours.
Most people go home and sleep, and by the next day I’ll side effects of epinephrine are gone and patient are left sore.
Your concern is not something you should be concerned with.
The two most important issues patient should be concerned with when it comes to getting Liposuction is first understanding your candidacy for the procedure and secondly finding the right provider.
Things go wrong with Liposuction all the time.
Lots of people are left disappointed, and worse.
All of these negative outcomes are almost all related to patient candidacy and provider selection.
Lots of people want to get Liposuction, but they don’t understand they’re not good candidates for the procedure.
People who are not good candidates for Liposuction cannot have quality results, regardless of who does the procedure.
 Patient who are excellent candidates for Liposuction have the potential of having high-quality outcomes if they find the right provider.
In the hands of the wrong provider they can be left disfigured.
Delivering consistent quality Liposuction is far more difficult than most people realize the number of plastic surgeons who have mastered this procedure is pretty small.
I would say 5% of plastic surgeons are good to excellent and one percent of plastic surgeon are Approaching mastering the procedure.
To find the right provider, I generally recommend people have multiple consultations at which point it is the patient’s responsibility to vet providers.
Ask providers to open up their portfolio and show you at least 50 patients worth of before and after pictures.
Being shown a handful of pre-selected images representing the best results is not sufficient to verify your provider has the skills necessary to deliver consistent quality outcomes.
I cannot emphasize these points enough.
Of all the things to be concerned about you should be worried about being left With bad outcomes.
This is common, this happens regularly and is 100% avoidable. Best,
Mats Hagstrom MD

How long does tachycardia from liposuction Epinephrine last?

Answers (8)

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