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Deaths related to liposuction.

R B Rao1, S F Ely, R S Hoffman

  • 1New York City Poison Control Center, Department of Surgery-Emergency Medicine, New York University Medical Center, NY 10016, USA. raorama@pol.net

The New England Journal of Medicine
|May 13, 1999
PubMed
Summary

Tumescent liposuction, a procedure using lidocaine, can be fatal. This study found deaths linked to lidocaine toxicity and drug interactions, highlighting safety concerns for this cosmetic surgery.

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Area of Science:

  • Plastic Surgery
  • Anesthesiology
  • Forensic Pathology

Background:

  • Tumescent liposuction involves subcutaneous lidocaine infusion and fat aspiration.
  • Recommended lidocaine doses are high (up to 55 mg/kg), but safety data are limited.
  • Adverse event reporting is not mandatory, obscuring complication rates.

Observation:

  • A review of New York City medical examiner cases (1993-1998) identified 5 deaths post-tumescent liposuction.
  • Patients received lidocaine doses from 10-40 mg/kg, with other sedatives like midazolam.
  • Causes of death included hypotension, bradycardia, fluid overload, and deep vein thrombosis with pulmonary embolism.

Findings:

  • Postmortem blood lidocaine levels in two patients were 5.2 and 2 mg/L.
  • Three deaths were attributed to severe hypotension and bradycardia of unclear origin.
  • Fatal outcomes were associated with lidocaine administration, potentially exacerbated by drug interactions.

Implications:

  • Tumescent liposuction carries a risk of mortality.
  • Lidocaine toxicity and drug interactions are potential contributing factors to fatal outcomes.
  • Further research into tumescent liposuction safety and improved adverse event monitoring is warranted.

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