Some have suggested sedation rather than general anesthesia as a method to reduce risk. However, the dilation occurring during general anesthesia is not significant, when understanding that some of these veins are much larger than 4 mm without dilation. Therefore, the type of anesthesia is far less important than avoiding these larger vessels.

Some have suggested that one avoids the area of the vascular pedicle and the sciatic nerve. These are both good recommendations, but veins beyond the pedicles are sufficiently large to allow emboli introduction from a purely biomechanical standpoint.

Truly, the one overarching theme in this is to use a cannula that is much larger than the vessels to be avoided. In addition, injection should occur into the areas where the vessels are the smallest possible in diameter. This only occurs at the level directly under the skin.

Does this completely prevent fat emboli?

At present, Dr. Hughes has performed 1500 BBLs with the method described. He has not encountered a fatal or nonfatal fat embolus.

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