Tips for TIVA for liposuction

[Sleeplessbordernights]

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Not us based.

Currently doing a lot plastic procedures, most peers here do a spinal plus sedation for liposuctions, but I want to start doing TIV, any tips? Some colleagues use and LMA but I’m not so comfortable with that as most lipos are 3 hours long plus a prone part

 

[DrOwnage]

Are these at stand alone plastic surgery centers? if so, then GETA every time.

 

[Simba1711]

I would just tube as well. Prone and Lma is not defensible in the US not sure about other countries.

 

[PainDrain]

So I did a fair bit of plastics using TIVA and an unsecured airway but you need several factors to be successful. First off, you need the right patient and by that I mean relatively normal BMI and otherwise healthy. The second factor is you need a good surgeon. Short of those two things I wouldn’t get involved in a prone TIVA “big MAC”. That being said, my formula for my TIVA cases was a scopolamine patch and glyco 30 minutes prior to case, 2-4mg midaz wheeling back, 25-50mg ketamine and then run the patient on proofol infusion. I didn’t use any opiates. Every 2 hours I would give another 2mg midaz and another 25-50mg ketamine. My patients always did well and didn’t remember a thing.

 

[norski]

Not us based.

Currently doing a lot plastic procedures, most peers here do a spinal plus sedation for liposuctions, but I want to start doing TIV, any tips? Some colleagues use and LMA but I’m not so comfortable with that as most lipos are 3 hours long plus a prone part

I do a lot of plastics, do tiva for 95/100. I go lma if less than 1.5hr total anesthesia, no gerd, and I have easy access to the airway. If prone, fat, gerd, difficult access to airway due to draping etc, tube every time.

Our surgeons do lipo wash for liposuctions and autologous fat transplants, which is something like 600mg lidocaine in 1000ml NS, and outside of huge abdominoplasties, belts or buttlifts, I rarely provide much more than a bit of ketamine alongside sleep MACs of propofol+remi. Happy, smiling extubations all over.

 

[IlDestriero]

What ever happened to the Ketafol guy?

 

[PainDrain]

What ever happened to the Ketafol guy?

Was he involved In Kanye’s mom’s case?

 

[zizzer]

The lengths people will go to not intubate somebody never cease to astound me.

 

[Southpaw]

The lengths people will go to not intubate somebody never cease to astound me.

agree. never understand it. it's like 'today i'm going to try as hard as possible to completely screw myself and my patient'.

 

[coffeebythelake]

The lengths people will go to not intubate somebody never cease to astound me.

Because they think it makes them look smooth

 

[sevo00]

Because they think it makes them look smooth

Laryngospasm under these general without controlled airway cases is the smoothest thing there is

 

[coffeebythelake]

agree. never understand it. it's like 'today i'm going to try as hard as possible to completely screw myself and my patient'.

But we all know that such things are driven by the surgeon telling patient they wont remember a thjng, and also they won't be intubated. They sabotage you with garbage they tell their patients.

 

[deleted87051]

What ever happened to the Ketafol guy?

Still around. Must be at least in his mid 70s by now but if politicians can do it…..

About Dr. Friedberg - Goldilocks Anesthesia Foundation

goldilocksfoundation.org

Was he involved In Kanye’s mom’s case?

No. Even mentions that case in one of his websites.

Dr. Barry Friedberg | Cosmetic Surgery Anesthesia - Office Based Surgery - Plastic Surgery Anesthesia - PK Technique1

drfriedberg.com

I do wonder how he uses BIS during browlifts.

 

[deleted87051]

The lengths people will go to not intubate somebody never cease to astound me.

It’s not clear from the OP’s post that they don’t intend to intubate. In fact he expresses concern about using an LMA. It seems to me that he wants to intubate and TIVA which is fine.

 

[thinkorswim]

I would just tube as well. Prone and Lma is not defensible in the US not sure about other countries.

Not every prone patient needs a tube. There are many cases that can be done prone with sedation and an LMA can work quite well in certain patients.

 

[Simba1711]

Yes I agree with you that some prone cases can be done with sedation. I disagree that Lma works well in prone cases. Op doesn’t work in the us and prone Lma is not standard of care in the us. You practice in the us ? Op states that he’s doing a 3 hour prone case and some colleagues stick an Lma in. At that point , why wouldn’t you just tube the patient. It’s not that much more work. An Lma or sedation for a 3 hour prone case provides minimal benefit and significant risk.

Not every prone patient needs a tube. There are many cases that can be done prone with sedation and an LMA can work quite well in certain patients.

 

[PainDrain]

Yes I agree with you that some prone cases can be done with sedation. I disagree that Lma works well in prone cases. Op doesn’t work in the us and prone Lma is not standard of care in the us. You practice in the us ? Op states that he’s doing a 3 hour prone case and some colleagues stick an Lma in. At that point , why wouldn’t you just tube the patient. It’s not that much more work. An Lma or sedation for a 3 hour prone case provides minimal benefit and significant risk.

Prone LMA for a 3 hour case? At that point you need to ask yourself what you are gaining by not intubating versus what you are risking in the event something goes south.

 

[amyl]

Prone lma is indefensible if something goes wrong

 

[zizzer]

It’s not clear from the OP’s post that they don’t intend to intubate. In fact he expresses concern about using an LMA. It seems to me that he wants to intubate and TIVA which is fine.

I know. I was just talking about the people the poster referred to regarding prone LMAs.

Not every prone patient needs a tube.

What's the point of thinking this way? There's essentially no downside to inserting a bit more plastic to go past the glottis rather than just superior to it. Tracheal stimulation is easily managed. By the way, I'm talking about for significant cases, not a short ERCP-like procedure or something. People doing LMAs for shoulder surgery, 3 hour prone cases, etc. seems crazy to me. It also seems like a huge pain in the ass for the anesthesiologist.

 

[jwk]

First thing I learned in private practice 42 years ago when we only had a mask or ETT. First indication for intubation - convenience of the anesthesiologist or anesthetist. It has served me well my entire career.