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2019, Número 1

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Cir Plast 2019; 29 (1)


Caso de muerte por lipoescultura: dictamen médico

Cuenca-Pardo J

Idioma: Español
Referencias bibliográficas: 56
Paginas: 120-146
Archivo PDF: 372.71 Kb.


RESUMEN

Las alteraciones previas que se presentan antes de la muerte súbita de aquellos pacientes que son operados de liposucción son: hipotensión, bradicardia, desaturación de oxígeno y asistolia. Las causas suelen ocurrir por embolia grasa, intoxicación por anestésicos, reflejo vagal, bloqueo epidural alto y por cardiopatía tóxica por consumo de cocaína. En los últimos cuatro años, hemos identificado seis casos en condiciones similares; en este trabajo, presentamos el dictamen experimentado en uno de ellos. Se trata del caso de una mujer de 43 años adicta a la cocaína y con una liposucción previa, peso corporal de 65 kg y una estatura de 1.65 m. A esta paciente le realizaron una liposucción del abdomen, costados y espalda; para ello, utilizaron solución salina más una ampolleta de adrenalina para vasoconstricción; le aspiraron 3,000 mL e infiltraron 300 mL de grasa en cada glúteo. Para este procedimiento, utilizaron doble bloqueo epidural con aplicación de tres dosis de anestésicos, sin embargo, la tercera dosis de anestésicos coincidió con la infiltración de grasa, lo que al momento hizo que la paciente presentara hipotensión, bradicardia y desaturación de oxígeno, que en pocos minutos evolucionó a la asistolia. No respondió a las maniobras de resucitación. El estudio de patología forense reportó vacuolas compatibles con grasa y determinó una embolia grasa masiva fulminante como causa de muerte. Son varias las entidades nosológicas mortales que se pueden presentar durante una lipoescultura y además todas presentan manifestaciones clínicas similares. Su severidad depende de la forma de responder de cada paciente, y suelen ser difíciles de diagnosticar y tratar. Con los datos obtenidos y el reporte del estudio forense no se puede determinar en forma categórica cuál causa provocó la muerte, por ello, creemos que hacen falta estudios encaminados a buscar estas patologías para establecer un verdadero diagnóstico.


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