الفهرس 
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Abstract
SUMMARY
Tumescent anesthesia describes the practice of injecting a dilute solution of LA combined with epinephrine and sodium bicarbonate into subcutaneous tissue until it becomes firm and tense. The primary benefits behind this technique is to avoid the supposed risks of general anesthesia, decrease blood loss in surgeries and provide postoperative anesthesia up to 18 hours. The underlying principle of tumescent anesthesia is that contrary to conventional thinking, larger doses of lidocaine, even up to 35-55 mg/kg body weight can be administered safely. Tumescent anesthesia has enormous potential for the future and while it is a safe practice, one needs to be acutely aware of the patient factors which are likely to correlate with increased perioperative risks. These factors include BMI, ASA classification and coexisting hepatic or renal insufficiency, as well as the presence of inhibitors or substrates for the P450 hepatic microsomal system.
Tumescent liposuction refers to the refinement of the traditional liposuction procedure. This technique involves subcutaneous infiltration of high volumes of crystalloid fluids containing low concentrations of lidocaine and epinephrine followed by suction-assisted aspiration of fat. The term tumescent liposuction specifically excludes the use
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of any additional anesthesia medications at dosages that have a significant risk for impairing the protective airway reflexes or for suppressing the respiratory drive. It is a method for performing liposuction surgery with the patient under local anesthesia. The preferential uptake of lidocaine into fat tissue delays its absorption and lowers its peak concentration in the blood which would otherwise give rise to lidocaine toxicity. Serial plasma lidocaine levels following tumescent anesthesia have been measured in several studies which have found peak lidocaine levels to be safely below the threshold for lidocaine toxicity. The use of TLA as the exclusive method of anesthesia has become the standard in liposuction, no report of death after use of this procedure has been published, and serious complications are extremely rare. It has been demonstrated to be a safe technique, with lower operative time and quick recovery in a large number of outpatients. Decreased operative time moreover reduces risk of thromboembolic phenomenon, heat loss, and the anesthetic solution exposure time, with lower absorption risk.
However, strict adherence to the guidelines and thorough knowledge of the pharmacological mechanism and aspects of
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the anesthetic technique chosen are essential to prevent complications related to liposuction procedure. The aim of this study was to evaluate and compare between conventional anesthetic methods (semi-tumescent anesthetic technique with either general anesthesia or spinal anesthesia) and True Tumescent Local anesthetic technique used for upper and lower abdominal liposuction procedure in order to know the ideal anesthetic technique providing less blood loss, longer postoperative analgesia, rapid postoperative recovery and less both surgical and anesthetic risks. Results were collected throughout the procedure and for 60 min postoperatively. This study was conducted in Ain Shams University hospitals, in Plastic Surgery Unit. It included patients undergoing elective upper and lower abdominal liposuction. The study involved 105 patients of both sexes, ages ranging from 21 to 45 years old and Body Mass Index (BMI) ranging from 25 to 30. The patients included were with American Society of Anesthesiologist (ASA) physical status I and II.
The patients were randomly divided into 3 equal groups, in which they received different anesthetic technique; group A received true tumescent anesthesia (n=35), group B received general anesthesia with semi tumescent anesthesia
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(n=35), and group C received spinal anesthesia with semi tumescent anesthesia (n=20).
On the basis of this limited and preliminary study, subjects undergoing abdominal liposuction with the three different anesthetic techniques were safe and did not experience any significant serious complication provided that the existing guidelines were meticulously followed. However, the exclusive use of true tumescent local anesthesia provided adequate intraoperative anesthesia and postoperative analgesia without the need for additional sedation or pain management, reduced the operation time and hospital stay more than the other two anesthetic techniques. Therefore, true tumescent anesthetic technique is recommended as an anesthetic technique in abdominal liposuction procedures