How to Reduce Risk of Hypothermia with TLA Infiltration Prior to Fat Aspiration

Every plastic surgeon knows that if patient hypothermia arises during surgery, patients are far more likely to suffer from myocardial events, infections, postoperative pain, slow incision healing and health, and increased blood loss. Under local anesthesia, the patient’s well-being suffers considerably when hypothermia develops.

During liposuction, the patient loses heat not only due to skin exposure, but also when any cooler-than-body-temperature tumescent local anesthesia solution is introduced into the body. Studies show that anaesthesia exposure causes 80% of heat loss in surgical patients, so it is critical to plan and implement warming methods before, during, and after fat aspiration procedures.

Since plastic surgery patients are more outcome-focused than medical surgery patients, plastic surgeons must take extra precautions to avoid negative events such as these, especially when it comes to safety. Simply reminding your team of why and how to prioritize patient warming can help you avoid serious heart, lung, pain, and incision issues among your patients.

Accurately Preheat the TLA Solution

An effective and crucial first step to keeping patients normothermic is to warm the anesthetic solution. Not only does the warm solution help patients maintain normal body temperature, but it also enhances vasoconstriction and hemostasis, two factors proven to decrease blood loss.

Jeffrey Klein, MD, the originator of the tumescent local anesthesia technique and promoter of patient warming, reminds us that the solution should be preheated to 37° to 39° C (98.6° to 102.2° F). Surgeons using devices engineered specifically for keeping TLA warm like Möller Medical’s Thermia Pro achieve this step with almost no effort and with a robust payoff.

Encourage a Warmed Patient Protocol Among Staff

Cryoanesthesia has long been discounted for many reasons. As a result, today’s medical literature indicates a consensus favoring the active warming of all surgical patients.

Byron Burlingame, RN is the senior perioperative practice specialist and author of the Association of Perioperative Nurses’ guidelines for perioperative safety. He laments that warming procedures can be left to the last minute – often too late to garner its benefits. Apparently, too many operating staff neglect to turn on their warming devices in time, forcing the patient’s body to work harder to achieve normothermia. His research has revealed that many patients roll into the operating theater with no pre-warming at all. Given the good research indicating the benefits of avoiding hypothermia, Burlingame finds these oversights concerning.

Burlingame also cautions , “The biggest barrier to preventing perioperative hypothermia is not having the best option that fits the patient.” He urges surgeons and nursing staff to take into account individual differences such as patient size, comorbidities, and procedure time, all of which affect hypothermia risk. Often, these unique factors call for using several methods such as pre-warming the patient with blankets and using a warmed anesthetic solution.

Burlingame and other medical experts also recommend that surgeons:

Share with patients how critical it is for them to stay warm and to let staff know when they feel cold.

Actively monitor the patient’s temperature before, during, and after the procedure. Nurses should measure and document the patient’s temperature the hour before they leave the ward or emergency department. Should the temperature be below 36.0 ° C, staff should begin active warming. Staff should measure the patient’s temperature before induction of anesthesia and every 15 to 30 minutes until surgery concludes. Continue monitoring postoperatively until the temperature stabilizes as hemodynamic changes and hypothermia risk persist at least 24 hours postoperatively.

Keep operating room temperature at 25 ° C or 77 ° F , even if surgeons and staff find it too warm.

Select candidates carefully – particularly for risky large volume liposuction procedures.

Train all staff involved in using aesthetic warming devices in best practices as delineated by the manufacturer.

Consider heating trays specifically engineered for the TLA solution.  Möller Medical’s anti-hypothermia solution is Thermia Pro, a set of heating trays that plastic surgeons use both independently and in combination with Möller’s Liposat® Pro / Pro plus infiltration pumps. Thermia Pro keeps the temperature of the preheated infiltration fluid constant and utilizes automatic temperature control to simplify surgeon workflow. Plastic surgeons worldwide are using Thermia Pro in liposuction, lipoma treatment, vein-stripping, sweat gland suction, abdominoplasty, and arthroscopy.

Large Volume Liposuction Requires More TLA

Large volume liposuction poses more hypothermia risks for two reasons. First, the labor-intensive surgery can take four hours or more, during which much of the patient’s skin is exposed, causing temperature loss. Then, more TLA fluid is required for the larger areas addressed. If nursing staff, the anesthesiologist, or the surgeon does not prioritize warming of the solution, the higher volumes of cool solution expose patients to higher risks of hypothermia. Given that high-volume liposuction is already riskier than standard liposuction, taking the time to warm the solution should be prioritized.

Surgeons must be meticulous in selecting patients for tumescent large volume liposuction, and manage perioperative factors closely. Complications include deep vein thrombosis, fat embolism, lung edema, infections, all of which can kill a patient. Given the simplicity of keeping the TLA solution warm, surgeons who include this step increase their patients’ odds of successful surgery and recovery.

Commit to Patient Warming for Practice Success

With most running concierge practices, plastic surgeons must bring the best service to their patients. When surgeons prioritize patient comfort and safety, patients know they are in good hands. Share this article with your colleagues and staff to remind them about the importance of keeping patients and TLA solution at 36° C or 96.8° F. Avoiding negative heart, lung, pain, and healing events is critical for any surgeon’s brand and reputation.

Need Help Choosing the Right Equipment?

Using only the most cutting-edge liposuction and fat-grafting equipment reassures patients about your dedication to safety. Moeller Medical prides ourselves on producing state-of-the-art aesthetics solutions crafted by German precision-engineering.