Another potential complication is local anesthetic systemic toxicity (LAST) since both the liposuction and gluteal fat injection use local anesthetics (usually lidocaine or bupivacaine). In particular, this could occur with substitution of bupivacaine for lidocaine.
LAST may explain some of the cardiac arrests within this cohort. Hallmarks of LAST include cardiovascular instability and wide QRS interval in the electrocardiogram.
In cases of LAST, the preferred treatment is intravenous lipid emulsion — widely known by the brand name “Intralipid”, but “Clinolipid” (Baxter Healthcare, Deerfield IL) has replaced the former brand in the US.
When treating LAST, the American Society of Regional Anesthesia recommends a bolus of 1.5 mL/kg of 20% lipid (~100 mL in a 70 kg patient) followed by a short infusion of 0.25 to 0.5 mL/kg/min over 20 minutes. Avoid using a bolus > 100 mL or an infusion of > 250 mL. https://www.asra.com/news-publications/asra-updates/blog-landing/guidelines/2020/11/01/checklist-for-treatment-of-local-anesthetic-systemic-toxicity
One Response to “Brazilian Butt Lift Procedure Can Result in Emergency Department Visits”
May 19, 2024
Michael E. Mullins, MD, FACEPAnother potential complication is local anesthetic systemic toxicity (LAST) since both the liposuction and gluteal fat injection use local anesthetics (usually lidocaine or bupivacaine). In particular, this could occur with substitution of bupivacaine for lidocaine.
LAST may explain some of the cardiac arrests within this cohort. Hallmarks of LAST include cardiovascular instability and wide QRS interval in the electrocardiogram.
In cases of LAST, the preferred treatment is intravenous lipid emulsion — widely known by the brand name “Intralipid”, but “Clinolipid” (Baxter Healthcare, Deerfield IL) has replaced the former brand in the US.
When treating LAST, the American Society of Regional Anesthesia recommends a bolus of 1.5 mL/kg of 20% lipid (~100 mL in a 70 kg patient) followed by a short infusion of 0.25 to 0.5 mL/kg/min over 20 minutes. Avoid using a bolus > 100 mL or an infusion of > 250 mL.
https://www.asra.com/news-publications/asra-updates/blog-landing/guidelines/2020/11/01/checklist-for-treatment-of-local-anesthetic-systemic-toxicity