What causes someone to go into cardiac arrest during surgery? How can I prevent it from happening to me?

Question

Hello, I am an African American female, I am 5’7 and weigh 220 lbs. I will be going into surgery to have liposuction and Brazilian butt lift, I would like to know what is the cause of someone going into cardiac arrest during surgery and how can I prevent it from happening to me. What should I do prior to surgery?

Semih Yildiz, MD, FEPOBRAS · Answer

Cardiac arrest during surgery is rare, but when it happens it is usually related to problems such as anesthesia or airway issues, abnormal heart rhythm, low oxygen, major bleeding, medication reactions, electrolyte problems, blood clots, fat embolism, or an unrecognized heart or lung condition. With liposuction and BBL, careful patient selection and avoiding overly aggressive surgery are especially important.

Before surgery, make sure you are being treated by a board-certified plastic surgeon in an accredited facility with a qualified anesthesia team. Have a proper medical clearance, disclose all medical problems, medications, supplements, nicotine use, sleep apnea symptoms, and any personal or family history of anesthesia or clotting issues. Ask about the surgeon's BBL safety protocol, DVT prevention, fluid management, and whether your BMI and overall health make the planned procedure safe to do now. If any chest pain, shortness of breath, fainting, or leg swelling occurs before or after surgery, seek urgent medical care.

Geuris Cruz Quiroz, MD · Answer

Thank you so much for your question. Cardiac arrest during surgery time can happens for numerous reasons. Common causes include hypoxia, hypovolemia, increased vagal activity due to medications routinely used during general or epidural, a heart attack, cardiomyopathy and some inherited heart conditions, congenital heart disease, heart valve disease, etc. A elective surgery is not an emergency, have a physical evaluation and have your cardiologist check you months prior to your surgery does not matter if you know you are healthy, cardiac arrest during surgery is rare, but this does not diminish the severity of this medical condition.

Hope this helps
Dr. Quiroz

Hope this helps
Dr. Quiroz

Daniel Barrett, MD · Answer

Dear pancaketopoundcake,
every plastic surgeon has his own preoperative protocol which he recommends to his patients. I would suggest you to discuss this with your plastic surgeon.
Daniel Barrett, MD
Certified, American Board of Plastic Surgery
Member, American Society of Plastic Surgery
Member, American Society of Aesthetic Plastic Surgery

Camille Cash, MD · Answer

In order to keep your risk low for surgery it is important that you are generally healthy, at a healthy stable weight, that you are a candidate for the procedure you are considering, that you select an experienced board certified plastic surgeon, and that you have your procedure performed in an accredited hospital or facility.  Begin by meeting with a board certified plastic surgeon near you to discuss your interest in the surgery as well as a review of your medical history.

Mats Hagstrom, MD (license on probation) · Answer

Cardiac arrest during surgery is extremely unlikely and rare.
Cardiac arrest simply means failure of the heart to properly function.
This can happen from severe coronary artery disease, Severe electrolyte imbalances and lack of perfusion such as massive bleeding. And some individuals there is a abnormal electrical circuitry in the heart making the heart have a propensity for developing fatal arrhythmias. None of these are likely on the young healthy person having an elective non-cardiac procedure.
Risk stratification should be done based on a combination of impact of risk compared to incidence or frequency.
Well your concern or relates to something that has massive impact it is also exceedingly rare. in other words it’s bad when it happens but it’s highly unlikely to happen.
My recommendations as patients considering cosmetic surgery especially liposuction and fat transfer procedures to worry not about the worst case scenario but instead worry about the more common risks.
Liposuction and to some degree fat transfer is a permanent and irreversible procedure.
If done poorly patients can be left disfigured and this is often not correctable.
This happens frequently enough that patients should be seriously concerned about it.
For that reason I recommend patients be very selective on choosing sufficiently talented and experienced providers with board certification by the American Board of plastic surgery.
Bing board-certified alone is insufficient to confirm someone has mastered either Liposuction or fat transfer.
Getting consistent quality results with these procedures is more difficult than people believe in mastering these procedures takes purposeful dedication and improving your results while doing thousands of cases.
Finding the right provider is actually quite challenging and involves a substantial amount of time and work.
I recommend patients to do this by scheduling multiple in person consultations with local board-certified plastic surgeons. when possible avoid traveling long distances for elective surgical procedures and avoid having virtual consultations whenever possible.
First and foremost familiarize yourself with your own candidacy for the procedure and get a good understanding of what quality results look like.
Start the process by getting appropriate pictures of your own body taken the same way plastic surgeons take before and after pictures. The pictures should be taken using the timer on your camera or having someone else take the picture from about 8 feet away wearing revealing undergarments showing your neck to your knees including the front, side and back standing upright in a neutral position.
Print a copy of these pictures and use them for reference when referring or looking at before and after pictures.
When reviewing before and after pictures either by yourself online or in person during a consultation look to find patients who have similar body characteristics to your own in the before pictures. patients who have different body characteristics are going to have a different potential outcome. It’s important to look at reference pictures only of patients who have similar candidacy for outcomes that you do. variables to look for that should be consistent include overall size, amount of skin laxity, degree of subcutaneous fat, body frame type, pregnancy related changes if applicable, presence or absence of visceral fat etc. etc.
It may not be easy to determine your own candidacy or even be able to recognize other patients who are of the same candidacy because some of these variables can be subtle and slight. A large bulging abdomen can be caused by multiple variables including skin laxity, exes subcutaneous fat, muscle separation from previous pregnancies and excess visceral fat. all four of those variables can give someone a large looking abdomen but only one of them is treated by Liposuction.
Once you have a pretty good idea of what good results look like for the procedure on patients who have similar characteristics to your own create a grading or rating system for BBL outcomes on patience with your body type. Do not include before and after pictures of patients who have different body characteristics.
During each consultation ask each provider to open up their portfolio and show you their entire collection of before and after pictures. Being shown a handful of preselected pictures which must likely represent the best results of their career is insufficient to get a clear understanding of what average results look like in the hands of each provider nor how many of these procedures a surgeon has actually performed. 
For reference I often use 50 as an appropriate minimum number Of before and after pictures and experience surgeons should be able to produce during a consultation. In reality highly experienced surgeons will have hundreds or even thousands of sets of the before and after pictures.
If someone has a limited collection of before and after pictures I suggest you ask how many procedures the surgeon has performed and ask to see more of their pictures.
Surgeons may be reluctant to open their portfolio and show you more of their pictures other than their preselected “show and tell” pictures.
Tell the surgeon that you want to see as many pictures as possible of patients with similar body characteristics to your own. You should also ask to see examples of excellent outcomes, average outcomes and less than outcomes.
You may need to push providers a bit to get them to start showing you the numbers of before and after pictures necessary to confirm someone’s skill, confidence and get a good understanding of what average results look like.
Preferred to transfer ask the provider how long after the surgery the postop pictures were taken. fat transfer result pictures should never be taken less than three months and preferably six months from the date of surgery. early fat transfer results can look very impressive but do not represent final results.
I suggest you also ask the provider what the revision rate is and what the revision policy is. all the plastic surgeons should have a certain revision rate. For liposuction and a fat transfer 5% is probably a healthy number.
Have a clear understanding of what the financial implications of the revision is based on their policies and how the decision regarding revisions is made.
For Liposuction make very clear exactly what areas are going to be treated and make sure each one of those areas is reviewed by looking at before and after pictures.
Look carefully at all after pictures making sure there are no skin contour irregularities in any treated area.
Look for transition zones between treated and untreated areas to see if these look natural.
Ask the surgeon what positions you’ll be put in during surgery to contour each area. turning patients during general anesthesia can be challenging. For a BBL most plastic surgeons start with the patients laying on their back and then turn patients one time for finishing up the work on the backside.
Personally I do the procedure without general anesthesia and I prefer to do most of the contouring with patients laying on their side. this includes doing the BBL.
Make notes of how thorough each provider is in discussing all aspects of the procedure including your medical history, risks and benefits, alternative procedures, preparation and recovery and of course how many before and after pictures they showed you and what the quality or grade or rating was for those. The best plastic surgeons are typically detail oriented and this generally means being detail oriented inside the operating room and outside the operating room. it should include a thorough consultation that is comprehensive and goes over all aspects of the procedure.
For me personally a thorough consultation takes about 45 minutes.
The number of consultations patients need to choose the right provider depends on how good someone is at vetting plastic surgeons.
There’s a learning curve from the patients perspective when it comes to having a meaningful quality consultation.
Patients need to learn how to vet plastic surgeons appropriately to get the information out of them that you need to make a good decision. If you rely strictly on the information that is given to you and don’t ask for the information you need you’re not going to get the useful decision-making information described above.
Patients need to take an active role in the consultation process and recognize that you are hiring the surgeon and have a full right to get confirmation of what their typical results look like and the amount of experience they actually have.
You should feel that the provider is a patient advocate who is treating you and offering you treatment options that are in your best interest.
Look for providers who display high level of honesty and integrity.
Continue having consultations until you feel very comfortable with choosing The right provider for your procedure.
When in doubt slow down and schedule more consultations.
At 220 pounds you are not a good candidate for liposuction and most likely not a good candidate for fat transfer either.
You didn’t include pictures but most likely your best option is to lose a substantial amount of weight at which point you may be a better candidate for a skin laxity surgery then liposuction.
Regardless the process of choosing a plastic surgeon is more or less the same regardless of what procedure you’re opting for.
Most plastic surgeons will not remove more than 5 L of fat in a single operation. In the state of Florida this is limited to 4 L.
4-5 L of fat is about 8 to 10 pounds of fat. For someone weighing 220 pounds 8 pounds of fat is insufficient to have a big impact. it may work well for limited areas like treating arms but for treating the entire torso one session of liposuction may be insufficient.
If the primary purpose is augmenting of your buttocks then this limitation is of less importance.
Best,
Mats Hagstrom MD

What causes someone to go into cardiac arrest during surgery? How can I prevent it from happening to me?

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