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Wiener Medizinische Wochenschrift

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01.05.2015 | brief report

Acute pulmonary edema following liposuction due to heart failure and atypical pneumonia

verfasst von: Prof. Dr. med. Uwe Wollina, MD, Dr. med. Andreas Graf, MD, Dr. med. Volkmar Hanisch, MD

Erschienen in: Wiener Medizinische Wochenschrift | Ausgabe 9-10/2015

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Summary

Microcannular liposuction in tumescent anesthesia is the most effective treatment for painful lipedema. Tumescent anesthesia is an established and safe procedure in local analgesia when performed according to guidelines. Major adverse effects are rare. In patients with advanced lipedema, however, the commonly presented comorbidities bear additional risks.

We report on post-surgical acute pulmonary edema after tumescent liposuction according to guidelines in a 52-year-old female patient with lipedema of the legs. We discuss in detail possible scenarios that might be involved in such emergency. In the present case the most likely was a retarded community acquired atypical pneumonia with aggravation of pre-existent comorbidities.

A combined treatment with intravenous b-lactam antibiosis, positive pressure ventilation, and continuous venovenous hemodialysis and filtration resulted in complete remission in a couple of days. In conclusion, tumescent liposuction of advanced lipedema patients should only be performed in well-trained centers with sufficient infrastructure.

Vorheriger Artikel Severe cyanide poisoning from an alternative medicine treatment with amygdalin and apricot kernels in a 4-year-old child

Nächster Artikel Depigmentation and hypertrophic scars after application of a fluid lactic acid tattoo eraser

Klein JA. The tumescent technique for liposuction surgery. Am J Cosmet Surg. 1987;4(4):263–7.

Klein JA. Tumescent technique chronicles: local anesthesia, liposuction, and beyond. Dermatol Surg. 1995;21(5):449–57.PubMedCrossRef

Sattler G, Sommer B, Hanke CW. Lehrbuch der Liposuktion. Stuttgart: Georg Thieme Verlag; 2003.

Katz BE, Sadick NS. Body contouring. Philadelphia: Saunders Elsevier; 2010.

Dill-Müller D. Lokale Anästhesieverfahren in der Dermatologie. Teil 2: Praktische Anwendungen. Hautarzt. 2012;63(2):145–60.PubMedCrossRef

Raymond SA, Steffensen SC, Gugino LD, Strichartz GR. The role of length of nerve exposed to local anesthetics in impulse blocking action. Anesth Analg. 1989;68(5):563–70.PubMedCrossRef

Conroy PH, O’Rourke J. Tumescent anaesthesia. Surgeon. 2013;11(4):210–21.PubMedCrossRef

Higuchi R, Fukami T, Nakajima M, Yokoi T. Prilocaine- and lidocaine-induced methematoglobinemia is caused by human carboxylesterase-, CYP2E1-, and CYP3A4-mediated metabolic activation. Drug Metab Dispos. 2013;41(6):1220–30.PubMedCrossRef

Tsuchiya H, Ueno T, Mizogami M, Takakura K. Local anesthetics structure-dependently interact with anionic phospholipid membranes to modify the fluidity. Chem Biol Interact. 2010;183(1):19–24.PubMedCrossRef

10.

Sattler G, Eichner S. Komplikationen bei Eingriffen am Fettgewebe. Hautarzt. 2013;64(3):171–9.PubMedCrossRef

11.

Augustin M, Maier K, Sommer B, Sattler G, Herberger K. Double-blind, randomized, intraindividual comparison study of the efficacy of prilocaine and lidocaine in tumescent anesthesia. Dermatology. 2010;221(3):248–52.PubMedCrossRef

12.

Hanke CW, Coleman WP III. Morbidity and mortality related to liposuction. Questions and answers. Dermatol Clin. 1999;17(4):899–902.PubMedCrossRef

13.

Tierney EP, Kouba DJ, Hanke CW. Safety of tumescent and laser-assisted liposuction: review of the literature. J Drugs Dermatol. 2011;10(12):1363–9.PubMed

14.

Meier-Vollrath I, Schmeller W. Lipoedema—current status, new perspectives. J Dtsch Dermatol Ges. 2004;2(3):181–6.PubMedCrossRef

15.

Chand M, Armstrong T, Britton G, Nash G. How and why do we measure surgical risk? J Royal Soc Med. 2007;100(11):508–12.CrossRef

16.

Schellong SM, Haas S. Perioperative Thromboseprophylaxe—Neue orale Antikoagulanzien und ihre Anwendung im Umfeld operativer Eingriffe. Anasthesiol Intensivmed Notfallmed Schmerzther. 2012;47(4):266–72.PubMedCrossRef

17.

Kiese M, Lörcher W, Weger N, Zierer A. Comparative studies on the effects of toluidine blue and methylene blue on the reduction of ferrihemoglobin in man and dog. Eur J Clin Pharmacol. 1972;4(2):115–8.PubMedCrossRef

18.

Svedman KJ, Coldiron B, Coleman WP III, et al. ASDS guidelines of care for tumescent liposuction. Dermatol Surg. 2006;32(5):709–16.PubMed

19.

Mysore V. IADVL Dermatosurgery Task Force. Tumescent liposuction: standard guidelines of care. Indian J Dermatol Venereol Leprol. 2008; 74(Suppl):S54–60.PubMed

20.

Venkataram J. Tumescent liposuction: a review. J Cutan Aesthet Surg. 2008;1(2):49–57.PubMedCentralPubMedCrossRef

21.

Habbema L. Safety of liposuction using exclusively tumescent local anesthesia in 3,240 consecutive cases. Dermatol Surg. 2009;35(11):1728–35.PubMedCrossRef

22.

Saleh Y, El-Oteify M, Abd-El-Salam A, Tohamy A, Abd-El-Elsayed AA. Safety and benefits of large-volume liposuction: a single-center experience. Int Arch Med. 2009;2(1):4.PubMedCentralPubMedCrossRef

23.

Böni R. Safety of tumescent liposuction under local anesthesia in a series of 4,380 patients. Dermatology. 2011;222(3):278–81.CrossRef

24.

Chia CT, Theodorou SJ. 1,000 consecutive cases of laser-assisted liposuction and suction-assisted lipectomy managed with local anesthesia. Aesthetic Plast Surg. 2012;36(4):795–802.PubMedCrossRef

25.

Starling J III, Thosani MK, Coldiron BM. Determining the safety of office-based surgery: what 10 years of Florida data and 6 years of Alabama data reveal. Dermatol Surg. 2012;38(2):171–7.PubMedCrossRef

26.

Rao RB, Ely SF, Hoffman RS. Deaths related to liposuction. N Engl J Med. 1999;340(19):1471–5.PubMedCrossRef

27.

Lehnhardt M, Homann HH, Daigeler A, Hauser J, Palka P, Steinau HU. Major and lethal complications of liposuction: a review of 72 cases in Germany between 1998 and 2002. Plast Reconstr Surg. 2008;121(6):396e–403e.PubMedCrossRef

28.

Martínez MA, Ballesteros S, Segura LJ, García M. Reporting a fatality during tumescent liposuction. Forensic Sci Int. 2008;178(1):e11–6.PubMedCrossRef

29.

Wollina U, Heinig B. Das Lipödem. Ärztebl Sachsen. 2012;23(11): 475–7.

30.

Schmeller W, Meier-Vollrath I. Tumescent liposuction: a new and successful treatment for lipedema. J Cutan Med Surg. 2006;10(1):7–10.PubMedCrossRef

31.

Stutz JJ, Krahl D. Water jet-assisted liposuction for patients with lipedema: histologic and immunohistologic analysis of the aspirates of 30 lipedema patients. Aesthet Plast Surg. 2009;33(2):153–62.CrossRef

32.

Wollina U, Goldman A, Heinig B. Microcannular tumescent liposuction in advanced lipedema and Dercum’s disease. G Ital Dermatol Venereol. 2010;145(2):151–9.PubMed

33.

Rapprich S, Dingler A, Podda M. Liposuction is an effective treatment for lipedema—results of a study with 25 patients. J Dtsch Dermatol Ges. 2011;9(1):33–40.PubMed

34.

Wollina U, Heinig B. Tumescent microcannular (laser-assisted) liposuction in painful lipedema. Eur J Aesthet Med Dermatol. 2012;2(2):56–69.

35.

Schmeller W, Hueppe M, Meier-Vollrath I. Tumescent liposuction in lipoedema yields good long-term results. Br J Dermatol. 2012;166(1):161–8.PubMedCrossRef

36.

Peled AW, Slavin SA, Brorson H. Long-term outcome after surgical treatment of lipedema. Ann Plast Surg. 2012;68(3):303–7.PubMedCrossRef

37.

Wollina U, Heinig B, Nowak A. Treatment of elderly patients with advanced lipedema: a combination of laser-assisted liposuction, medial thigh lift, and lower partial abdominoplasty. Clin Cosmet Investig Dermatol. 2014;7:35–42.PubMedCentralPubMedCrossRef

38.

Langendoen SI, Habbema L, Nijsten TE, Neumann HA. Lipoedema: from clinical presentation to therapy. A review of the literature. Br J Dermatol. 2009;161(5):980–6.PubMedCrossRef

39.

Klein JA. The tumescent technique. Anesthesia and modified liposuction technique. Dermatol Clin. 1990;8(3):425–37.PubMed

40.

Stockmann S, Spies E, Gehring H, et al. Evaluation and application of a high performance liquid chromatographic method for prilocaine analysis in human plasma. Clin Lab. 2013;59(1–2):127–32.PubMed

41.

Kwiatt ME, Seamon MJ. Fat embolism syndrome. Int J Crit Illn Inj Sci. 2013;3(1):64–8.PubMedCentralPubMedCrossRef

42.

Şenen D, Atakul D, Erten G, Erdoğan B, Lortlar N. Evaluation of the risk of systemic fat mobilization and fat embolus following liposuction with dry and tumescent technique: an experimental study. Aesthet Plast Surg. 2009;33(5):730–7.CrossRef

43.

Triana L, Triana C, Barbato C, Zambrano M. Liposuction: 25 years of experience in 26,259 patients using different devices. Aesthet Surg J. 2009;29(6):509–12.PubMedCrossRef

44.

Gurd AR, Wilson RI. The fat embolism syndrome. J Bone Joint Surg Br. 1974;56B(3):408–16.PubMed

45.

Gilliland MD, Coates N. Tumescent liposuction complicated by pulmonary edema. Plast Reconstr Surg. 1997;99(1):215–9.PubMedCrossRef

46.

Trott SA, Beran SJ, Rohrich RJ, Kenkel JM, Adams WP, Jr, Klein W. Safety considerations and fluid resuscitation in liposuction: an analysis of 53 consecutive patients. Plast Reconstr Surg. 1998;102(6):2220–9.PubMedCrossRef

47.

Ozmen S, Kusza K, Ulusal BG, Pryor L, Siemionow M, Zins JE. Hemodynamic changes and fluid shifts after large-volume fluid infiltration: results from a porcine model. Ann Plast Surg. 2010;64(1):83–8.PubMedCrossRef

48.

Schmeller W, Meier-Vollrath I. Langzeitveränderungen nach Liposuktion bei Lipödem. LymphForsch. 2010;14(2):17–28.

49.

Rassler B. Contribution of σ- and b-adrenergic mechanisms to the development of pulmonary edema. Scientifica (Cairo). 2012;2012:829504.

50.

Ramirez JA, Anzueto AR. Changing needs of community-acquired pneumonia. J Antimicrob Chemother. 2011;66(Suppl 3):iii3–9.PubMedCentralPubMed

51.

Girard N, Cottin V, Hot A, Etienne-Mastroianni B, Chidiac C, Cordier JF. Infections opportunistes et sarcoïdose. Rev Mal Respir. 2004; 21(6 Pt 1):1083–90.PubMedCrossRef

52.

Kelly DM, Greene CM, Meachery G, et al. Endotoxin up-regulates interleukin-18: potential role for gram-negative colonization in sarcoidosis. Am J Respir Crit Care Med. 2005;172(10):1299–307.PubMedCrossRef

53.

Quinkler M, Beuschlein F, Hahner S, Meyer G, Schöfl C, Stalla GK. Adrenal cortical insufficiency—a life threatening illness with multiple etiologies. Dtsch Ärztebl Int. 2013;110(51–52):882–8.PubMedCentralPubMed

54.

Maestre A, Gil V, Gallego J, Aznar J, Mora A, Martin-Hidalgo A. Diagnostic accuracy of clinical criteria for identifying systolic and diastolic heart failure: cross-sectional study. J Eval Clin Pract. 2009;15(1):55–61.PubMedCrossRef

55.

King M, Kingery J, Casey B. Diagnosis and evaluation of heart failure. Am Fam Physician. 2012;85(12):1161–8.PubMed

Titel: Acute pulmonary edema following liposuction due to heart failure and atypical pneumonia
verfasst von: Prof. Dr. med. Uwe Wollina, MD
Dr. med. Andreas Graf, MD
Dr. med. Volkmar Hanisch, MD
Publikationsdatum: 01.05.2015
Verlag: Springer Vienna
Erschienen in: Wiener Medizinische Wochenschrift / Ausgabe 9-10/2015
Print ISSN: 0043-5341
Elektronische ISSN: 1563-258X
DOI: https://doi.org/10.1007/s10354-014-0333-6

Springer Medizin Österreich

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