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Liposuction in the Outpatient Setting
Managing Your OR
Liposuction in the Outpatient Setting “Managing Your OR” focuses on various aspects of aesthetic surgery in the ambulatory surgical setting.
S
pecial considerations apply when performing liposuction in an office operating room.
Equipment Purchase a high-quality, reliable aspirator for your operating room. As with all of your equipment, the aspirator should be periodically serviced and checked for electrical safety. Ideally, you should have a back-up aspirator in case your primary aspirator fails. A less expensive alternative is to have an arrangement with another facility or plastic surgeon to obtain a back-up aspirator within minutes should you need one. A reliable infusion apparatus for preinjection of fluids into the subcutaneous space is an important if not indispensable piece of equipment. The infusion apparatus may be of the roller-pump type or gas-pressurized chambers. Again, a back-up infusion device is mandatory and may consist simply of a pressurized blood infusion bag where pressure is maintained by hand-pumping. An ultrasonic system is desirable for large-volume procedures, certain anatomic areas, and secondary liposuctions but is not an absolute necessity.
Safety Guidelines Establish an upper limit for volume removal in the outpatient setting. Obviously, this limit will vary depending on the patient’s size, general state of health, and age, as well as whether ancillary procedures are being performed. The degree of experience and skill of the surgeon will also influence his or her comfort level with large-volume removals in the outpatient setting. There is almost uniform agreement that when total aspirate volume exceeds 5000 mL, the operation becomes more physiologically disruptive, and patients should be kept overnight in the hospital. For some patients, however, 5000 mL is too much to remove in the outpatient setting, and a lower limit should be used.
Formulation of wetting solution should be stringently supervised by the surgeon. Errors in dosage can have a fatal outcome. In general it is safer to have the solution made up well before the start of the operation and put in labeled containers rather than having it in open containers on the instrument table.
Gerald H. Pitman, MD, New York, NY, is a board-certified plastic surgeon and an ASAPS member.
Patient Comfort A separately controlled heating element for the operating room permits the surgeon to raise ambient temperature to a suitable level for patients undergoing liposuction. By keeping operating room temperature at 78° to 80° F, the patient will be much more comfortable and tend not to shiver after surgery. Use of a forced hot air heating blanket in the recovery area will also help the patient maintain a normal core body temperature. Consider not using compression garments for most areas. Although there is some slight increase in swelling and bruising in the immediate postoperative period, the result at 6 weeks is the same whether or not garments are used. The calves and ankles are a notable exception, and garments should be worn for 6 weeks in these areas. Preoperative education for home care is particularly important for patients undergoing liposuction. They need full information on how to protect their linens, furniture, and carpets from postoperative fluid leakage. An elevated toilet seat, which can be purchased at any surgical supply store, is also a good idea for the first few days after liposuction of the thighs and buttocks. Following these guidelines will help to ensure a satisfying outpatient surgical experience for your patients undergoing liposuction. ■ Reprint orders: Mosby, Inc., 11830 Westline Industrial Drive, St. Louis, MO 63146-3318; phone (314) 453-4350; reprint no. 70/1/98163
AESTHETIC
SURGERY
JOURNAL
~
MARCH/APRIL
1999
167
Liposuction in the Outpatient Setting “Managing Your OR” focuses on various aspects of aesthetic surgery in the ambulatory surgical setting.
S
pecial considerations apply when performing liposuction in an office operating room.
Equipment Purchase a high-quality, reliable aspirator for your operating room. As with all of your equipment, the aspirator should be periodically serviced and checked for electrical safety. Ideally, you should have a back-up aspirator in case your primary aspirator fails. A less expensive alternative is to have an arrangement with another facility or plastic surgeon to obtain a back-up aspirator within minutes should you need one. A reliable infusion apparatus for preinjection of fluids into the subcutaneous space is an important if not indispensable piece of equipment. The infusion apparatus may be of the roller-pump type or gas-pressurized chambers. Again, a back-up infusion device is mandatory and may consist simply of a pressurized blood infusion bag where pressure is maintained by hand-pumping. An ultrasonic system is desirable for large-volume procedures, certain anatomic areas, and secondary liposuctions but is not an absolute necessity.
Safety Guidelines Establish an upper limit for volume removal in the outpatient setting. Obviously, this limit will vary depending on the patient’s size, general state of health, and age, as well as whether ancillary procedures are being performed. The degree of experience and skill of the surgeon will also influence his or her comfort level with large-volume removals in the outpatient setting. There is almost uniform agreement that when total aspirate volume exceeds 5000 mL, the operation becomes more physiologically disruptive, and patients should be kept overnight in the hospital. For some patients, however, 5000 mL is too much to remove in the outpatient setting, and a lower limit should be used.
Formulation of wetting solution should be stringently supervised by the surgeon. Errors in dosage can have a fatal outcome. In general it is safer to have the solution made up well before the start of the operation and put in labeled containers rather than having it in open containers on the instrument table.
Gerald H. Pitman, MD, New York, NY, is a board-certified plastic surgeon and an ASAPS member.
Patient Comfort A separately controlled heating element for the operating room permits the surgeon to raise ambient temperature to a suitable level for patients undergoing liposuction. By keeping operating room temperature at 78° to 80° F, the patient will be much more comfortable and tend not to shiver after surgery. Use of a forced hot air heating blanket in the recovery area will also help the patient maintain a normal core body temperature. Consider not using compression garments for most areas. Although there is some slight increase in swelling and bruising in the immediate postoperative period, the result at 6 weeks is the same whether or not garments are used. The calves and ankles are a notable exception, and garments should be worn for 6 weeks in these areas. Preoperative education for home care is particularly important for patients undergoing liposuction. They need full information on how to protect their linens, furniture, and carpets from postoperative fluid leakage. An elevated toilet seat, which can be purchased at any surgical supply store, is also a good idea for the first few days after liposuction of the thighs and buttocks. Following these guidelines will help to ensure a satisfying outpatient surgical experience for your patients undergoing liposuction. ■ Reprint orders: Mosby, Inc., 11830 Westline Industrial Drive, St. Louis, MO 63146-3318; phone (314) 453-4350; reprint no. 70/1/98163
AESTHETIC
SURGERY
JOURNAL
~
MARCH/APRIL
1999
167