Severe fat embolism in perioperative abdominal liposuction and fat grafting

Abstract

Background and objectives: Fat embolism syndrome may occur in patients suffering from multi-ple 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 grad-ual 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; PCO 2 = 51 mmHg; PO 2 = 52 mmHg; BE = −8; HCO 3 = 18 mEq L −1 , and lactate = 6.0 mmol L −1 . Transthoracic echocar-diogram 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 (Glas-gow 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 echocardiog-raphy 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 Severe fat embolism in perioperative abdominal liposuction and fat grafting 325 factor correction (early fixation of fractures or suspension of liposuction). The multiorgânico involvement indicates a worse prognosis.