Shaking from Tumescent Fluid During Liposuction?

                  Shaking
during and after tumescent liposuction, although unusual can occur for a
variety of reasons.  The most
common causes are intravascular absorption of epinephrine and lowered core body
temperatures.

                  In
the vast majority of cases the effect of epinephrine is relatively short.  Shaking caused by epinephrine tends to
resolve quickly.

                  When
shaking during and after tumescent liposuction is prolonged, the most likely
cause is lowered core body temperature. 
Lowered body temperature can occur for a variety of reasons and every
effort should be made to avoid this problem.

                  During
tumescent liposuction large areas of the body’s surface area are obligatorily
exposed to open air.  In addition,
patients are given significant amounts of tumescent fluid in the area being
treated.  Both of these factors can
adversely impact core body temperature.

                  For
these reasons, it’s important to keep the operating room warm and whenever
possible utilize a warming blanket. 
In addition it’s important to use warm tumescent fluid.  When these steps are taken uncontrolled
shaking is usually not an issue.

First, these are not convulsions; they are likely a side effect from the epinephrine.  We like to use 20mg of Valium, 50mg of Hydroxyzine, and this seems to keep people very comfortable.  Try to take the meds 30 minutes prior to the procedure so it will have time to work. 

The shaking you experienced was not a "convulsion", as you listed, but rather a normal physiological reaction of you body trying to keep warm.  The injected fluid makes your body cooler, and the epinephrine in the solution vasoconstricts your skin cappillaries so blood flow is reduced.  This combination can lead to shaking "chills", especially if you are somewhat nervous during the procedure.  Though it is really nothing to worry about (assuming you are properly monitored), tell your surgeon that is was alarming to you and he/she will give you something to sedate you more at your next procedure.

You had a normal reaction to the epinephrine - just as if your own body had produced a larger amount of it in a stressful situation. Next time, keeing your body warm may help, as may using a lower dose of the epinephrine (if possible and OK with your surgeon).

On the rare occasion that someone "shakes" we have always found that a warm blanket helps offset the cold from the room and the fluids. There is a variance of opinion as to whether the fluid should be warmed, as some surgeons feel that cool helps reduce swelling and bruising.

This a quite frequent occurence. The reasons are: cooling from the tumescence solution and the epinephrin in the solution. Keeping a patient warm during the procedure helps. 

Epinephrine can definitely make someone shake, but not everyone has this side-effect. It is important to note that this is NOT an allergy to epinephrine, but a normal side-effect.

You mention that you are having this procedure done again in a few months, so you're worried about the shaking happening again.  If you seeing a board-certified plastic surgeon (not a "cosmetic surgeon"), you would have the option of going to the OR and having your procedure done under general anesthesia, where shaking and nervousness wouldn't be an issue.  You could also likely have treated all your areas at one time, instead of having two operative sessions in the office. 

If you are having the next procedure in the office anyway, you might consider requesting additional valium, as 7.5 mg may not have been enough for you.  Klonopin wouldn't help.

If room temperature fluid is used, it can cool the body down to a point that you will shake.  This can be rectified by heating the fluid or turning the temperature of the room higher.  It might also be related to the epinephrine in the solution.  In any case, it is usually self limitted and should not be a problem as long as the proper dosing of lidocaine is adhered to.

Liposuction is a popular and very effective procedure to recontour the body. When we performed the procedure, we typically add water mixed with medication into the tissue before we begin the liposuction. This fluid allows us to remove fat safely and more effectively. After the surgery, patients can expect to have some drainage from the liposuction incisions of this fluid. When a patient is receiving like a suction, we carefully monitor their vital signs and close of the fluid that they have received to make sure that their electrolytes are balanced. It is possible to have some shaking if you have a significant imbalance of your electrolytes. The most important thing is to contact your surgeon as soon as possible and let them know your concerns. They will assess you and may order labs to make sure that everything is in balance.
 

Shaking usually occurs because the person is cold. The main reason I have seen for shaking during liposuction is that not enough care has been given to patient comfort and warmth. It would be easy to have a room and numbing fluid that are relatively cool. Also take into consideration the fact that patients are partially unclothed during the procedure. The abdomen, waist, or legs may be open to the air and wet from excess numbing fluid.
The way we handle this is to try to address each of these issues. The bed and numbing fluid are warmed. The patient is covered with surgical blankets and we regularly ask if they are warm enough. With the tumescent technique, the person is awake, so we can pay close attention to all issues of safety and comfort.