Liposuction Technique and Lymphatics in Liposuction

Use of the anesthesia in liposuction technique An estimated 70% of all elective surgery is performed in an outpatient setting, and more than 50% of aesthetic plastic surgeons perform most of their procedures in an office setting.Economic considerations play a major role in the shift to ambulatory surgery. Because of greater efficiency, these outpatient surgical units have greater cost-effectiveness. Advances of monitoring capabilities and the adoption of monitoring standards of the American Society of Anesthesiologists (ASA) are credited for a reduction of perioperative morbidity and mortality.Advances in pharmacology have resulted in a greater diversity of anesthetic agents with rapid onset, shorter duration of action, and reduced morbidity.The advent of minimally invasive procedures has further reduced the need for hospital-based surgeries. Regulatory agencies such as the American Association of Accreditation of Ambulatory Surgery (AAAASF) and the Accreditation Association for Ambulatory Health Care (AAAHC) have helped establish minimum stan dards of care for surgical locations where anesthesia is administered. As a consequence of the shift away from hospital based surgery, the surgeon has adopted a more important role in the medical decision-making with respect to anesthesia. Frequently, the surgeon decides on the location of surgery, the extent of the preoperative evaluation, the type of anesthesia to be administered, the personnel to be involved in the care and monitoring of the patient, the postoperative pain management, and the discharge criteria used. Therefore, it is incumbent on the surgeon to understand current standards of anesthesia practice. If the surgeon chooses to assume the role of the anesthesiologist, then he or she must adhere to the same standards that are applied to the anesthesiologist. While the morbidity and mortality of anesthesia has decreased,risk awareness of anesthesia and surgery must not be relaxed. If the intended surgical procedure requires gen eral anesthesia or enough sedative-analgesic medication (SAM) to increase the probability of loss of the patient’s life-preserving protective reflexes (LPPRs), then, according to the law in some states, the surgical facility must be accredited by one of the regulatory agencies (AAAASF, Institute for Medical Quality, Joint Commission on Accreditation. Regardless of which type of facility is selected or the type of anesthesia planned, the operating room must be equipped with the type of monitors required to fulfill monitoring standards established by the ASA Optimally, the surgical facility should have ready access to a laboratory in the event a stat laboratory analysis is required. Finally, a transfer agreement with a hospital must be established, in some states, in the event that an unplanned admission is required. An anesthesiologist or a certified nurse anesthetist (CRNA) may administer anesthesia. The surgeon may prefer to perform the surgery using exclusivelylocal tumescent anesthesia without parenteral sedation, especially in limited liposuction. However, many surgeons add parenteral sedative or analgesicmedications with the local anesthetic. If the surgeon chooses to administer parenteral SAMs, then another designated, licensed, preferably experienced individual should monitor the patient throughout the perioperative period.Use of unlicensed, untrained personnel to administer parenteral SAM and monitor patients may increase the risk to the patient.It is also not acceptable for the nurse monitoring the patient to double as a circulating nurse.Evidence suggests that anesthesia-related deaths more than double if the surgeon also administers the anesthesia [18]. Regardless of who delivers the anesthesia, the surgeon should preferably maintain current advanced cardiac life support (ACLS) certification and all personnel assisting in the operating room and recovery areas must maintain basic life support certification.At least one ACLS-certified health provider must remain in the facility until the patient has been discharged. Medical tips on how to cure the liposuction are in chirurgia estetica