Jeffrey A. Klein

Lidocaine toxicity with tumescent liposuction : A case report of probable drug interactions

When two or three drugs are each substrates for the same enzyme, there is a possibility for an adverse drug reaction when used simultaneously. Lidocaine is rapidly and almost exclusively eliminated by CYP3A4. The newer antidepressant selective serotonin reuptake inhibitors (SSRI) such as sertraline are metabolized by the hepatic enzymes CYP3A4 and CYP2D6. The benzodiazepines such as midazolam (Versed) and diazepam (Valium) are also metabolized by the CYP 3A4 isoenzymes. The specific cytochrome P450 enzyme responsible for the metabolism of flurazepam has not been identified.

Tumescent Technique Chronicles: Local Anesthesia, Liposuction, and Beyond

The reality of tumescent liposuction is just the opposite of what one might expect based on common sense and experience. The dilution of a local anesthetic solution of lidocaine and epinephrine does not weaken its effect, it actually enhances the degree of anesthesia, and vasoconstriction. Although microcannulas remove less fat per unit of time, they actually permit the removal of greater volumes of fat than traditional liposuction cannulas with diameters of 6-10 mm. Patients find that there is less pain associated with tumescent liposuction than liposuction by general anesthesia. It is disconcerting when clinical expectations are not congruent with clinical reality. However, the concept is better understood, its applications will extend well beyond its present horizon.

Anesthetic formulation of tumescent solutions.

There is no standard or official recipe for the tumescent anesthetic solutions. The actual concentrations of lidocaine and epinephrine should depend on the areas to be treated and clinical situation. This article discusses the safe usage of tumescent solutions and the proper procedures and precautions to take when mixing these solutions.

POST-TUMESCENT LIPOSUCTION CARE: Open Drainage and Bimodal Compression

The goals of post-liposuction care must be to minimize edema, bruising, and patient discomfort. The postoperative pain and edema resulting from sutured incisions and prolonged post-liposuction compression is an irrational remnant from the days before the tumescent technique. This article discusses various issues involving post-liposuction care.

Use of Photodynamic Therapy and Sterile Water to Target Adipose Tissue.

BACKGROUND Neither photodynamic therapy (PDT) nor sterile water has not been well studied for the treatment of adipose tissue. OBJECTIVE This investigation studied 2 different modalities, verteporfin PDT and sterile water, on adipose tissue compared with control. MATERIALS AND METHODS Four light-skinned pigs were used. Test sites received verteporfin PDT or sterile water injection. Control sites received injection of verteporfin without PDT, normal saline injection, no intervention, exposure to laser only, or insertion of a needle or cannula only. Sites were evaluated clinically, by ultrasound, and with histology 4 to 6 weeks after treatment. RESULTS There was a decrease in adipose tissue by ultrasound after verteporfin PDT (15%, p < .001) and sterile water (2%, p = .23). Verteporfin without PDT showed a decrease in adipose tissue (17%, p = .21). All other control sites showed an increase in adipose tissue. Histologically, verteporfin PDT and sterile water showed moderate damage (median Grade 2, p < .001) 4 to 6 weeks after intervention. CONCLUSION Verteporfin decreased adipose tissue after treatment. Sterile water injection had a statistically significant effect on adipose tissue histologically but did not substantially decrease the adipose tissue by ultrasound 4 to 6 weeks after intervention. Longer follow-up may be needed.