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Liposuction Surgery Can Kill - U.S. Study
Updated 4:15 PM ET May 12, 1999
By Gene Emery

BOSTON (Reuters) - Surgery designed to give men and women "killer" bodies may itself be a killer. A study published in Thursday's New England Journal of Medicine concludes liposuction can be fatal.

The examination of 1,001 New York City deaths attributable to medical procedures has uncovered five cases where the cosmetic surgical procedure turned deadly, often because it included giving high doses of the usually benign painkiller lidocaine.

"The true incidence of complications and death is unknown," researchers said because doctors are not required to report such deaths or mistakes associated with the usually elective surgical operation known as tumescent liposuction.

About 270,000 such procedures are performed in the United States annually. The surgery involves inserting a hollow tube into the layer of skin where fat cells reside. Fluid containing water, lidocaine and other chemicals is pumped into the layer under pressure, and fat cells are sucked out.

In cases where more than three pounds (1.4 kg) of fat tissue are removed, doctors may need to use several liters of fluid.

"Tumescent liposuction is not a trivial procedure because it has the potential to kill otherwise healthy persons," concluded the research team led by Dr. Rama Rao of the New York University Medical Center.

Rao and her colleagues said drug interactions, fluid balance guidelines, blood clotting issues and the amount of fat removed from the body "should be reevaluated for this popular cosmetic procedure."

"I think the most alarming thing about this is that the deaths were really unexplained by any single, clear mechanism," Rao told Reuters in a telephone interview.

Two of the patients suddenly developed low blood pressure, a slowed heart rate and then the heart stopped.

In a third case a woman was treated in a hospital for two days because of residual pain. Two hours after being discharged from the hospital she developed labored breathing and her heart began beating inefficiently. She died after three days in a coma.

A fourth woman became lightheaded 18 hours after her surgery and died.

Details on the fifth patient were not released because the researchers were unable to get the family's consent.

When lidocaine is used for liposuction, the acceptable amount of lidocaine in the fluid injected under the skin ranges from 10 to 88 milligrams per kilogram of patient body weight. The American Academy of Dermatologists has said doses higher than 55 milligrams should be safe because most of the drug stays out of the bloodstream.

"So some patients are getting 10, 15 times higher than the recommended dose of lidocaine," Rao said.

"There could be several factors involved in the deaths," she said. For example if the patient is taking other drugs, the excess lidocaine may overload the liver, allowing a toxic amount of the painkiller to accumulate.

Genetics might also play a role, Rao speculated.

Based on the findings "my hope is that a little more caution is applied to the use of lidocaine," Rao said. "It's a safe drug in a setting where its use is well studied. But it's not clear that these doses (used in liposuction) are safe, especially where the drug is not required to maintain the health of the patient or save the life of the patient."

"A little more thought must go into whether this drug is necessary," Rao said.

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