The Sun-Sentinel newspaper is abuzz with the tragic story of laser liposuction gone horribly wrong in Miramar, Florida. Allegedly, a healthy mother of three underwent laser-assisted liposuction at a “med-spa” setting using only local anesthesia. Towards the end of the procedure, however, she had a severe seizure, becoming hypoxic. She is now on life-support, in the ICU, at the nearby Cleveland Clinic, and has been pronounced brain-dead.First, my sincere condolences to the family.
While I do not have any “insider information”, here are some important details about the case that are public information. I think there is a lot that can be learned from this tragic situation.
1) The physician involved was not board-certified in any surgery-related field. Not Plastic Surgery, not General Surgery, not Ob-Gyn. Always check credentials. Ask “Which Board are you certified by, Doctor?”
It is as yet unknown whether this physician had hospital privileges to perform liposuction. That’s a useful test: if you’re not permitted to do the surgery in a hospital, you probably shouldn’t try to do it in an office!
2) The procedure was performed in a “med-spa”, which was not licensed either as an outpatient surgery center or an office surgery center. It is unknown whether the med-spa even had any basic emergency equipment for resuscitation.
Surgery, including cosmetic surgery, should only be performed in accredited surgical facilities. Our office surgery center, for example, is registered with the State of Florida, and has been inspected by AAAASF, one of the big 3 national accreditation agencies.
3) There have been no reports of a trained anesthesiologist or nurse-anesthetist being present to supervise the patient’s airway and monitor the vital signs. It is also unknown whether the physician was trained in ACLS (advanced life support) protocols or not.
At our office, for example, all physicians (surgeon and anesthesiologists) and recovery room nurses are ACLS certified. All of our major surgery cases have a board-certified anesthesiologist present from start to finish, to monitor the patient.
4) One of the new “minimally-invasive” laser liposuction devices was used. But let’s call it for what it is….
Liposuction is an invasive surgical procedure, with lots of tunnelling under the skin. It’s real surgery – and should only be performed by fully trained, credentialled surgeons. A weekend course or two does not cut it.
5) This liposuction case did not involve general anesthesia. Instead, the procedure was done with tumescent anesthesia, which is commonly used for small to medium sized liposuction cases. Tumescent anesthesia usually involves injecting significant volumes of a dilute lidocaine mixture into the fat, prior to performing the liposuction. It is usually a safe technique, in trained hands. If excessive doses of lidocaine are used, however, lidocaine toxicity can result. One of the classic signs of a lidocaine overdose is a seizure. The other possible causes of a seizure in this case would be hypoxia, from airway mismanagement or oversedation.
Should lidocaine toxicity and seizure occur, it can usually be safely controlled and treated with an stat IV dose of valium, together with proper airway management. It should take but seconds to get this inexpensive drug from the nearby “crash cart”.
The combination here is tragic: An non-surgeon physician, working in a non-regulated setting, probably without safety equipment to treat complications, has a patient who has a major seizure (possibly from lidocaine overdose), becoming hypoxic, developing a severe brain injury.
There are so many take home messages here. Cosmetic surgery, like all surgery, can have complications, and properly trained surgeons take many safety precautions to avoid issues and keep their patients safe. Please choose your surgeon and the surgical facility wisely.