Respiratory Variation of Carotid Doppler Peak Velocity in Liposuction Fluid Management
Phase: NA
Conditions: Lipodystrophy
Sponsor: TJ Plast Advanced Center for Plastic Surgery

 
 
 
 
Respiratory Variation of Carotid Doppler Peak Velocity in Liposuction Fluid 
Management 
 
 
 
 
 
 
 
Principal Investigator 
 
Sergio Soto Hopkins M.D. 
 
 
 
 
Associated Investigators 
 
Hector Milla M.D. 
TJ Plast Advanced Center for Plastic Surgery 
 
Israel Espino Gaucin, M.D. 
TJ Plast Advanced Center for Plastic Surgery 
 
 
 
 
 
 
Protocol ID: R-2023-02 
 
JUNE 25 2023 
 
 

 
Study Description 
 
 
The research will involve 50 female patients who have undergone liposuction and will be 
divided into two groups. 
Group Intraoperative fluid ratio: Fluid administration will be determined by the 
intraoperative fluid ratio. This ratio is calculated by dividing the sum of subcutaneous 
infiltration and intravenous fluid by the total aspirate volume. Depending on the aspiration 
volume, it will be maintained at 1-1.4. 
 
Group Carotid Artery Peak Velocity Variation: Participants will be given a fluid 
maintenance rate of 1.5 ml/kg/h. To determine fluid responsiveness, the carotid artery peak 
velocity variation (ΔVPeak-CA) will be measured before, during, and after the procedure. If 
the ΔVPeak-CA goes above 15%, the patient will receive a fluid bolus of lactated ringer 
solution at a rate of 4-6 ml/kg over 10-15 minutes, and the team will re-measure fluid 
responsiveness 10 minutes after each ΔVPeaK-CA. 
 
During the examination, a single cardiothoracic anesthesiologist will use a 13-6 MHz linear 
probe (Fujifilm Sonosite M-Turbo) to measure the peak velocity of the carotid artery on the 
left side. The sample volume will be positioned at the center of the lumen, 2 cm from the 
bulb, and a pulsed wave Doppler examination will be conducted. 
 
To measure the ΔVPeak-CA, the investigators will calculate the maximum and minimum 
values during one respiratory cycle. This will be done by using the formula: 100x (maximum 
peak velocity - minimum peak velocity) / [(maximum peak velocity + minimum peak 
velocity)/2]. 
 
Surgical technique  
 
The superwet tumescence technique will be the only method utilized for infiltration during 
the procedure. All participants will undergo power-assisted liposuction, and a single 
surgeon will operate. The wetting solution will contain 1000cc of normal saline and 2mg of 
epinephrine in a 1:500,000 ratio. The total Infiltration volume will depend on the 
participant's surgery characteristics.  The total amount of aspiration will depend on the 
participant and surgery plan and can vary between 2500 to 5000 ml 
 
During the surgical procedure, the investigators will monitor vital signs such as blood 
pressure, heart rate, temperature, oxygen levels, and urine output. Additionally, the 
investigators will track the amount of fluids given and removed and the volume of blood 
aspirated.  
 
Following surgery, participants will be hospitalized for 24 hours. During this time, the 
investigators will closely monitor the plethysmography variability index (PVi) in both groups. 

If the PViexceeds 15%, patients will receive a ringer lactate fluid bolus of 4-6 ml/kg over 10-
15 minutes. Additionally, the investigators will keep track of their urine output, total fluid 
balance, and vital signs 
 
 
Arms and interventions 
 
 
Experimental: Group Carotid Artery Peak Velocity Variation 
 
Participants will be given a fluid maintenance rate of 1.5 ml/kg/h. To determine fluid 
responsiveness, the carotid artery peak velocity variation (ΔVPeak-CA) will be measured 
before, during, and after the procedure. If the ΔVPeak-CA goes above 15%, the participant 
will receive a fluid bolus of lactated ringer solution at a rate of 4-6 ml/kg over 10-15 minutes, 
and the team will re-measure fluid responsiveness 10 minutes after each ΔVPeaK-CA. 
 
 
 
Active Comparator: Group Intraoperative fluid ratio 
 
The intraoperative fluid ratio will determine fluid administration. This ratio is calculated by 
dividing the sum of subcutaneous infiltration and intravenous fluid by the total aspirate 
volume. Depending on the aspiration volume, it will be maintained at 1-1.4. 
 
This ratio is calculated by dividing the sum of procedure subcutaneous infiltration and 
intravenous fluid by the total aspirate volume during surgery 
 
 
 
Outcome Measures 
 
Primary Outcome 
 
1.- Mean Postoperative PVi 
 
Following surgery, participants will be hospitalized for 24 hours. Throughout this period, we 
will keep a close eye on the Plethysmography Variability Index in both groups. The PVi is a 
dynamic index that measures the relative variability of the plethysmography waveform 
detected noninvasively from a pulse oximetry sensor, ranging from 0 to 100. By 
automatically calculating the dynamic changes that occur during the respiratory cycle, it 
uses the detected amplitudes. A higher variability in the plethysmography waveform has 
been linked to preload dependence and fluid responders. If the PVi exceeds 15%, the 
patient will receive a fluid bolus of lactated ringer solution at a rate of 4-6 ml/kg over 10-15 
minutes. 

2.- Postoperative intravenous fluid balance 
 
Following surgery, participants will be hospitalized for 24 hours. During the postoperative 
period, the investigators will keep track and document the exact volume of fluid 
administered in milliliters. 
 
Secondary Outcome Measures 
 
3.- The intraoperative total volume of urine in the participant´s catheter bag 
 
During the intraoperative period, the investigators will measure and record the total volume 
of urine accumulated in the participant's catheter bag over the surgery period and will 
report urine output measured in milliliters per kilogram per hour. 
 
 
4.- The postoperative total volume of urine in the participant's catheter bag 
 
During the postoperative period, the investigators will measure and record the total volume 
of urine accumulated in the participant's catheter bag over a 24-hour period and will report 
urine output measured in milliliters per kilogram per hour. 
 
5.- Mean arterial blood pressure during hospitalization 
 
Following surgery, participants will be hospitalized for 24 hours. During this time, the 
investigators will monitor mean arterial pressure. 
 
6.- The intraoperative intravenous fluid balance 
 
Throughout the surgical procedure, the investigators will meticulously monitor and record 
the precise amount of fluid administered in milliliters. 
 
 
Eligibility 
 
Inclusion Criteria 
 
• 
Female patients between 21 and 60 years old 
• 
Liposuction with or without abdominoplasty 
• 
American Society of Anesthesiologists Ӏ & ӀӀ. 
 
Exclusion Criteria 
 
• 
History of previous liposuction surgery 
• 
American Society of Anesthesiologist III 

• 
Coagulation disorders 
• 
Cardiopulmonary disorders 
 
 
 
Statistical analysis  
 
 
We will express continuous variables as means with standard deviation and percentages for 
categorical variables. To test the data statistically, we will use Student's t-test or Chi-square 
test depending on the appropriateness. P-values less than 0.05 will be considered 
statistically significant. The analyses and calculations will be performed using SPSS Statistics 
21.0 (IBM, NY, USA). 
   
 
References 
 
 
Song Y, Kwak YL, Song JW, Kim YJ, Shim JK. Respirophasic carotid artery peak velocity 
variation as a predictor of fluid responsiveness in mechanically ventilated patients with 
coronary artery disease. Br J Anaesth. 2014 Jul;113(1):61-6. doi: 10.1093/bja/aeu057. 
Epub 2014 Apr 9.   PubMed ID: 24722322 
 
Ibarra-Estrada MA, Lopez-Pulgarin JA, Mijangos-Mendez JC, Diaz-Gomez JL, Aguirre-Avalos 
G. Respiratory variation in carotid peak systolic velocity predicts volume responsiveness in 
mechanically ventilated patients with septic shock: a prospective cohort study. Crit 
Ultrasound J. 2015 Dec;7(1):29. doi: 10.1186/s13089-015-0029-1. Epub 2015 Jun 
26.   PubMed ID: 26123610 
 
Wang G, Cao WG, Zhao TL. Fluid management in extensive liposuction: A retrospective 
review of 83 consecutive patients. Medicine (Baltimore). 2018 Oct;97(41):e12655. doi: 
10.1097/MD.0000000000012655. Erratum In: Medicine (Baltimore). 2018 
Nov;97(44):e13212.   PubMed ID: 30313055   
 
 
 
 
 
 
 
 
 
 
 

Informed Consent Form 
 
 
Title of Research:    
 
Respiratory Variation of Carotid Doppler Peak Velocity in     Liposuction Fluid Management 
 
Principal Investigator: Sergio Soto Hopkins M.D 
                                         Phone: +526621191347 
                                         Email: Sergio_sotohopkins@hotmail.com 
 
Institutional Contact: TJ Plast Advanced Center for Plastic Surgery  
Plaza Corporativa Torre Mol Local C1 Al C5. Calle Francisco Javier    
Mina No. 9288 
                                        Tijuana Baja California 
 
                                        Phone: +52 664 634 2367 
 
 
1.- Introduction and Purpose of the Study 
 
The aim of this research is to compare two techniques that anesthesiologists can utilize to 
calculate the correct amount of intravenous fluid required for a liposuction operation. 
 
During the investigation, the vital signs of the participants will be closely monitored 
including blood pressure, heart rate, temperature, oxygen levels, and urine output. The 
investigators will also keep track of the amount of fluids administered and removed, as 
well as the volume of blood drawn. 
 
 
 
 
2.- Subject participation 
 
The investigators anticipate enrolling 50 participants in this study. To be eligible, 
participants must be aged between 21 and 60 years old and have scheduled liposuction 
with or without abdominoplasty. 
 
 
3.- Potential risks and discomforts 
 
You can be confident that the surgery will not entail any extra hazards aside from those 
typically linked to liposuction. It will be executed in the customary manner, with all the 

precautions.  Throughout the procedure and during your hospital stay, the 
anesthesiologist will provide care for you, just as they do for all patients. 
 
 
 
4.- Potential Benefits 
 
This study will assist us in identifying the most effective approach to determine the 
required amount of fluids for our patients during liposuction. 
 
 
5.- Privacy and Confidentiality 
 
We will keep all the personal information you provide us, such as your name, address, and 
telephone number, confidential. This includes your clinical data and hospital test results. 
Your privacy is our top priority, and we will not disclose any information that could reveal 
your identity when we publish or present the study's results at conferences. For record-
keeping purposes, we will assign you a number instead of using your name to protect your 
identity. 
 
 
 
 
 
 
 
 
 
Name and signature of the subject                                                             Name and signature of the person obtaining the consent 
 
 
 
 
 
 
 
 
         Witness 1                                                                                                                                                         Witness 2