Does General Anesthesia Help to Avoid Using So Much Lidocaine?

I need lipo in several areas but keep hearing about lido poison. Is there any way to avoid using so much lido so you can do more areas. Does it matter what kind of anesthesia you use in relation to how much lido is used? Thanks

Doctor Answers 13

Lidocaine toxicity and general anesthesia vs local anesthesia

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The amount of lidocaine in the bloodstream is usually the dangerous factor. This can be minimized by calculating the weight of the patient, the amount of local anesthetic given, and the amount of epinephrine used (which delays the absorption of the lidocaine, making it safer).

Whether under local anesthesia, IV sedation or light general anesthesia, we prefer to have a board certified anesthesiologist there to monitor the safety of the patient in all significant liposuction cases. It is the sole responsibility off the anesthesiologist to monitor the safety of the patient. They have ways of detecting whether the lidocaine level has reached too high a level, and ways of treating it should that occur. In addition to careful dosage calculation, this is an additional safety measure.

Generally when a case is done under local anesthesia, more local anesthetic is required than for the same case under general anesthetic.

There is no question in my mind that having a board certified anesthesiologist there is safer than not having one there for the case.

Beverly Hills Plastic Surgeon
4.9 out of 5 stars 195 reviews

Every medicine is a poison. It is just a matter of dose.

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It is possible to have enough lidocaine as to be poisoned by it. But this is also true if you have too much tylenol or aspirin. What makes a drug safe is the difference between the dose needed to be effective and the dose that is associated with toxicity.

There is no question the safest form of liposuction is pure tumescent liposuction using only lidocaine local anesthesia and holding the dose at or bellow a total dose of 35 mg/kg. The patient is awake for the procedure perhaps having had a small dose of valium orally to reduce anxiety. Provided the procedure is carried out with small gauge cannulas at a slow pace, they entire procedure is surprisingly comfortable. The lidocaine sticks around in the fat for about 24 hours which means that it also provides most of the pain control needed after surgery. Most patients do not need narcotics after surgery. The added benefit is very little trauma, almost no blood loss, and many people find they can return to their work out and work within two days. The risk of dying from this type of liposuction is estimated to be one in 300,000 cases. Dermatologist primarily practice liposuction this way.

Contrast this liposuction under general anesthesia. It is common for a wetting solution to be used. This can resemble the tumescent solution used for pure tumescent liposuction. However, the general anesthetics and the lidocaine are metabolized by the same pathways in the liver, this means that there is increase toxicity with this combination. This was a problem when ultrasonic liposuction was introduced. General plastic surgeons not accustom to using large volumes of wetting solution needed to do so to avoid tissue burns with the ultrasonic hand pieces. The result was a rash of deaths which led to laws in States like California and Florida limiting how surgeons could perform liposuction. At the hit of this problem, some studies found the risk of dying from this combination of liposuction as high as one in 5,000 cases. However, by limiting the wetting solution and reducing the overall size of the procedures done, the risk of dying from this type of liposuction is now thought to be one in 50,000 cases which is comparable to the risk associated with most out patient surgery.

You might ask, if liposuction under local anesthesia is so much safer, why does anyone do it any other way. The answer is complicated. First general plastic surgeons are trained in their residencies to operate on patients who are under general anesthesia. So they are accustom to this level of anesthesia.

For the surgeon there is a huge advantage. With the patient completely asleep, the liposuction can be performed very quickly. A tummy liposuction that takes a dermatologist 3 hours under pure tumescent anesthesia can be completed in 45 minutes under general anesthesia. Therefore, liposuction under general anesthesia is much more profitable.

Also there is the law of large numbers. A risk of one death in 50,000 is still so rare that most surgeons in their entire career will not experience an operative death from liposuction. They begin to think it is not really a significant risk. However, ask yourself how you feel about choose between a procedure where the risk of dying is 10 times higher. This is the reason so many people choose to have liposuction with a dermatologist rather than a general plastic surgeon.

Kenneth D. Steinsapir, MD
Beverly Hills Oculoplastic Surgeon
4.9 out of 5 stars 26 reviews

Lidocaine dosage can be calculated ahead of time before liposuction.

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Your surgeon will have a good idea of how much fat will be removed from the areas you are considering.  You can do significantly more liposuction under general anesthesia than under local anesthesia. It is simply a matter of dosage. We use a lot less lidocaine in a liter of tumescent solution when the patient is asleep.

Liposuction can be done awake, but the goals have to be more modest since we have a limit on how much lidocaine can be used to keep you comfortable.

Francisco Canales, MD
Santa Rosa Plastic Surgeon
5.0 out of 5 stars 35 reviews

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The current recommendation by the American Society of Plastic Surgeons is to limit the TOTAL amount of lidocaine for liposuction to 35mg/kg.  This means for a 70 kg person (154 pounds), the total amount of lidocaine should be 2450 mg, which typically means 2-3 liters of fluid (depending on how dilute the lidocaine is in the bag). 

If you have chosen to have your liposuction done without any intravenous sedation or general anesthesia, then the amount of lidocaine given has to be more since it takes more lidocaine to anesthetize the area completely.  This may require more than one procedure.

Depending on your size and weight, you may be able to have your procedure done in one setting, if done under general anesthesia.  Still if you are going to have more than 5 liters (1.3 gallon) of fat and fluid removed, the recommendation by our society is to stay in a post-recovery facility over-night, so that your fluid balance can be monitored.

There is really no right or wrong answer here. It is just a matter of how you want the procedures done.

Michael A. Jazayeri, MD
Santa Ana Plastic Surgeon

Genral Anesthesia vs Local Anesthesia

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Absolutely. In lipo cases under general anesthesia many surgeons use lidocaine in their tumescent solution with the idea that you will have more pain control post op. All competent surgeons will be acutely aware of how much lidocaine you are receiving during the case to avoid lidocaine toxicity. If you are in the zone of having to give too much lido you can merely dilute the solution more. I personally do not believe in massive lipo so I never go any where near those levels. Some surgeons simply omit the lido entirely in cases that are done under general anesthesia. Under local there is simply no way to avoid the use of lidocaine and then one would have to be counting in larger cases.

Clayton L. Moliver, MD
Houston Plastic Surgeon
4.4 out of 5 stars 36 reviews

Lidocaine Toxicity - Liposuction under General Anesthesia VS Awake / Tumescent Anesthesia

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Lidocaine, like all drugs, is a double edged tool. It is a wonderful drug that relieves pain and can stop certain heart rhythm abnormalities but in higher dosages it can be fatal. With the tumescent solution we use in Liposuction, we infuse large amounts of dilute Lidocaine into the fat. The larger the amount of lidocaine used, the closer we reach the threshold of lidocaine toxicity and serious side effects.

So WHEN to use awake Tumescent Liposuction and when to use Tumescent solution with LESS Lidocaine under General Anesthesia? Small liposuction cases where a lot of side to side turning is not needed CAN be done under awake, Tumescent anesthesia liposuction UNLESS the patient is anxious and would prefer otherwise. Large volume liposuction cases which would require much higher doses of Lidocaine (and risk toxicity) may be better done under general anesthesia regardless of the professed bravery / stoicism of the patient.

Hope this helped.

Peter A. Aldea, MD
Memphis Plastic Surgeon

General anesthesia and liposuction

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General anesthesia allows the surgeon to work on more areas that would not be sufficiently numb if only tumescent anesthetic were used because the latter has a limit to how much lidocaine is used. This limit is based on the patient's weight, age and medication (prescription and over-the-counter) that is taken regularly that can affect the liver's metabolism of the lidocaine. However, removing too much fat, under general anesthesia without tumescent lidocaine can increase the risk of more blood loss and fluid shifts that can cause medical concerns. So there are limits with both procedures.

Ronald Shelton, MD
Manhattan Dermatologic Surgeon
4.9 out of 5 stars 39 reviews

General anesthesia help to avoid using so much lidocaine

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 Yes it does. There are measurements concerning the loading doses of lido. to be used and time frame in amounts vs time of duration.

Hope that helps Dr. B

Lidocaine with lipo under a general

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If a general anesthetic is done when a patient is having liposuction then lidocaine is not needed . Depending on what type of general is used lidocaine may help the anesthetic by not requiring as deep an anesthetic. These things can and should be worked out between the surgeon and anesthesiologist prior to surgery. The dose of lidocaine can be substantially reduced if the procedure is done under a general.

Walter D. Gracia, MD
Fort Worth Plastic Surgeon
4.7 out of 5 stars 3 reviews

General Anesthesia and Lidocaine

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Yes, if you have general anesthesia, the total amount of lidocaine can be limited since you will not feel the surgery. If you are having awake liposuction, then a larger amount of lidocaine is required per area to make sure that you do not feel the procedure. Because of this, fewer areas can be treated with awake liposuction than with traditional liposuction under general anesthesia. Good luck.

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.