Severe fat embolism in perioperative abdominal liposuction and fat grafting

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• 作者：Rodrigo de Lima e Souza^a ; ^b ; ^c ; ^{digoanest@hotmail.com" class="auth_mail" title="E-mail the corresponding author} ; ^{digoanest@icloud.com" class="auth_mail" title="E-mail the corresponding author} ; Bruno Tavares Apgaua^a ; Joã ; o Daniel Milhomens^a ; Francisco Tadeu Motta Albuquerque^a ; Luiz Antô ; nio Carneiro^a ; Má ; rcio Henrique Mendes^a ; Tiago Carvalho Garcia^a ; Clerisson Paiva^a ; Felipe Ladeia^a ; Deiler Cé ; lio Jeunon^a
• 关键词：Fat embolism ; Intraoperative ; Liposuction
• 刊名：Brazilian Journal of Anesthesiology (English Edition)
• 出版年：2016
• 出版时间：May-June 2016
• 年：2016
• 卷：66
• 期：3
• 页码：324-328
• 全文大小：698 K

文摘

Fat embolism syndrome may occur in patients suffering from multiple trauma (long bone fractures) or plastic surgery (liposuction), compromising the circulatory, respiratory and/or central nervous systems. This report shows the evolution of severe fat embolism syndrome after liposuction and fat grafting.

Case report

SSS, 42 years old, ASA 1, no risk factors for thrombosis, candidate for abdominal liposuction and breast implant prosthesis. Subjected to balanced general anesthesia with basic monitoring and controlled ventilation. After 45 min of procedure, there was a sudden and gradual decrease of capnometry, severe hypoxemia and hypotension. The patient was immediately monitored for MAP and central catheter, treated with vasopressors, inotropes, and crystalloid infusion, stabilizing her condition. Arterial blood sample showed pH = 7.21; PCO₂ = 51 mmHg; PO₂ = 52 mmHg; BE = −8; HCO₃ = 18 mEq L⁻¹, and lactate = 6.0 mmol L⁻¹. Transthoracic echocardiogram showed PASP = 55 mmHg, hypocontractile VD and LVEF = 60%. Diagnosis of pulmonary embolism. After 24 h of intensive treatment, the patient developed anisocoria and coma (Glasgow coma scale = 3). A brain CT was performed which showed severe cerebral hemispheric ischemia with signs of fat emboli in right middle cerebral artery; transesophageal echocardiography showed a patent foramen ovale. Finally, after 72 h of evolution, the patient progressed to brain death.

Conclusion

Fat embolism syndrome usually occurs in young people. Treatment is based mainly on the infusion of fluids and vasoactive drugs, mechanical ventilation, and triggering factor correction (early fixation of fractures or suspension of liposuction). The multiorgânico involvement indicates a worse prognosis.