Anesthesia In Dermatologic Surgery Research Articles

Anatomic Location Influences Duration of Local Lidocaine Anesthesia in Dermatologic Surgery.

Although the onset and duration of local anesthetics are well-defined, how the anatomic site influences the duration of local anesthetics has not been well characterized in dermatology. To define the duration of local anesthesia by anatomic site. This was a prospective study. Adult healthy volunteers and patients undergoing Mohs micrographic surgery were invited to participate. The nose and the shin were chosen to represent highly and poorly vascularized anatomic sites, respectively. A total of 0.5 mL of buffered 1% lidocaine hydrochloride with 1:100,000 epinephrine was injected subcutaneously into each anatomic site of each participant. A pinprick test was used to assess adequate anesthesia until return of baseline sensation or visit completion. This study enrolled 25 participants. Time to return of sensation was significantly shorter on the nose compared with the shin ( p < .0001). On the nose, there was an association between male sex and shorter time to return of sensation. Time to return of sensation is significantly shorter on the nasal ala compared with the shin, suggesting that patients may regain sensation sooner on highly vascularized sites. Defining the duration of local anesthetics based on anatomic regions is important for treatment planning in dermatologic procedures.

Benefits, safety and side effects of tumescent local anesthesia in dermatologic surgery in infants.

Tumescent local anesthesia (TLA) plays an important role in dermatosurgical procedures. TLA has several benefits such as long-lasting anesthesia, reduced bleeding during surgery and the avoidance of general anesthesia-associated complications. Convenience and a favorable risk profile along with a broad spectrum of indications are further reasons why TLA is increasingly applied in infants as well. There are not only a variety of indications for surgical excisions in infancy, such as congenital nevi, but also substantial benefits when performing these excisions at an early age. These include the smaller size of the lesions as well as the unproblematic wound healing and tissue regeneration in infancy. Nevertheless, several aspects need to be considered when applying TLA in infants including dosing, altered plasma protein binding and the need for adequate and long-lasting pain control.

Sticky boundary to retain a thick layer of eutectic mixture of local anesthetics cream at surgical site for effective anesthesia

Topical anesthetic creams are widely used to provide local anesthesia in dermatologic surgery. To achieve the desired effect, a certain degree of penetration is required. This effect can be achieved by occlusion with a transparent dressing. However, the use of dressings for occlusion can lead to spillage of the cream, which can result in a poor anesthetic effect.1 The recommended dose of the drug is 1.5-2 g per 10 cm2 area of skin, which might not be retained under the occlusive dressing.2 Furthermore, because of poor drug diffusion, the effect of occlusion is poor in areas with physiologically thick skin, such as the feet and upper back, or in pathologically hyperkeratotic, acanthotic, or fibrosed skin.

Safety of Local Intracutaneous Lidocaine Anesthesia Used by Dermatologic Surgeons for Skin Cancer Excision and Postcancer Reconstruction: Quantification of Standard Injection Volumes and Adverse Event Rates.

Intracutaneous lidocaine is used for anesthesia in dermatologic surgery for skin cancer excision and repair with exceedingly low incidence of reported adverse events. To measure (1) the quantity of lidocaine typically used for facial skin cancer excision and reconstruction; and (2) the frequency and character of associated adverse events. Survey study of dermatologic surgeons with longitudinal reporting. Reported practice during 10 business days: (1) mean volume of 1% lidocaine per skin cancer excision; (2) maximum per excision; (3) mean per reconstruction; and (4) maximum per reconstruction. A total of 437 of 1,175 subjects contacted (37.2%) responded. Mean per excision was 3.44 mL (SD: 2.97), and reconstruction 11.70 mL (10.14). Maximum per excision was 6.54 mL (4.23), and reconstruction was 15.85 mL (10.39). No cases of lidocaine toxicity were reported, diagnosed, or treated. Incidence of adverse events possibly anesthesia related was >0.15%, with most (0.13%) being mild cases of dizziness, drowsiness, or lightheadedness from epinephrine tachycardia. Toxicity associated with local anesthesia other than lidocaine was not studied. Volumes of lidocaine in skin cancer excision and repair are modest and within safe limits. Lidocaine toxicity is exceedingly rare to entirely absent. For comparable indications, lidocaine is safer than conscious sedation or general anesthesia.

Tumescent Anesthesia in Dermatologic Surgery

Tumescent anesthesia is a local anesthetic technique that consists of the infiltration of a large volume of solution with a low concentration of the local anesthetic agent and epinephrine. Its main advantages are that it achieves adequate anesthesia and a significant reduction in intraoperative and postoperative bleeding, leading to greater ease of surgery with the added benefit that it facilitates tissue dissection. This technique can be used safely for anesthesia of large areas, given that systemic absorption of the local anesthetic and vasoconstrictor agent is limited, reducing the incidence of systemic side effects. The simplicity and numerous applications and benefits of this technique make it very useful in current dermatologic surgical practice.

Sentinel node biopsy in melanoma of the trunk and the extremities in tumescent local anesthesia.

The sentinel node biopsy (SNB) of axilla and groin is a common staging procedure and can be done in both general anesthesia and local anesthesia. To investigate the efficacy of tumescent local anesthesia (TLA) as a widely used type of local anesthesia in dermatologic surgery for the SNB of axilla and groin. From 1999 to 2002, 195 patients underwent a SNB of axilla or groin. A 0.1% tumescent solution with prilocaine was used. In cases in which local anesthesia did not produce complete analgesia, there was additional medication using Midazolam and Tramadol. In 74.9% of the patients, TLA was sufficient as the sole method. In 25.1%, sedation became necessary. Additional medication was required for 31.9% of the patients with SNB in the axilla and for 17.3% with SNB in the groin; 26.6% of the patients with SNB of both axillas and 25% with SNB of the axilla and the groin received additional medication using Midazolam. Two patients with a SNB of the axilla received a combination of Midazolam and Tramadol. SNB of the axilla and the groin in TLA is a good alternative to other anesthetic techniques, for example, general anesthesia or infiltration anesthesia.

Iontophoresis as a Tool for Anesthesia in Dermatologic Surgery

Iontophoresis as a Tool for Anesthesia in Dermatologic Surgery

Pediatric Anesthesia in Dermatologic Surgery: When Hand-Holding is Not Enough

Dermatologic procedures in children may require the use of topical and local anesthetics, sedatives, and general anesthesia. To review developments in topical and local anesthetics, sedatives, and general anesthesia relevant to dermatologic procedures in children. Review of the medical literature. Topical anesthetics, including EMLA and liposome-encapsulated lidocaine cream, amethocaine, cetacaine, and benzocaine products may be useful for decreasing the pain of cutaneous procedures including intra-lesional lidocaine infiltration. A variety of sedative and hypnotic agents may be utilized for pediatric dermatology procedures, and guidelines for their appropriate use have been published. General anesthesia for dermatologic procedures in the pediatric population is appropriate for a variety of procedures including laser treatment of capillary malformations. A variety of anesthetic, analgesic, and sedatives may be useful for pediatric cutaneous surgery.

Iontophoresis as a tool for anesthesia in dermatologic surgery: an overview.

One of the biggest challenges of performing dermatologic surgery procedures is to minimize pain. Not only will the experience of each patient be enhanced by increased comfort, but the medical and aesthetic results achieved by the physician will be facilitated as well. Iontophoresis is the use of electrical impulses to drive molecules into the skin. Anesthetic agents are one type of medicine that can be delivered in such a way. There is a tremendous potential for the applications of iontophoresis to be expanded. As our understanding of the technique increases we will be able to modify the skin's surface as well as the individual agents we wish to transport.

Pediatric Anesthesia in Dermatologic Surgery

Pediatric Anesthesia in Dermatologic Surgery

Local anesthesia in dermatologic surgery

With the growth of dermatologic surgery the appropriate use of local anesthesia is becoming an important issue. Thoughtful use of local anesthesia can improve the patient's experience and facilitate the surgical procedure. In this review we discuss historical and pharmacologic aspects of local anesthetic agents. Emphasis is placed on clinical considerations, including contraindications, toxic reactions, and detailed descriptions of anesthetic use.

Analgesia Induced by Nitrous Oxide and Oxygen as an Adjunct to Local Anesthesia in Dermatologic Surgery: Results of Clinical Trials

Clinical trials were carried out to determine if analgesia induced by nitrous oxide and oxygen could be useful as an adjunct to local anesthesia in dermatologic surgery. Patients readily accepted the procedure. The analgesia obtained reduced anxiety and pain, and no important adverse side effects were encountered. Overall, the agents and method are effective and have advantages over more commonly used agents and methods used as adjuncts to local anesthesia.

Induction of anesthesia in dermatologic surgery.

The Journal of Dermatologic Surgery and OncologyVolume 5, Issue 12 p. 944-944 Department Ask the Experts Daniel A. Gross M.D., Daniel A. Gross M.D. Tarzana, CaliforniaSearch for more papers by this author Daniel A. Gross M.D., Daniel A. Gross M.D. Tarzana, CaliforniaSearch for more papers by this author First published: December 1979 https://doi.org/10.1111/j.1524-4725.1979.tb00787.xCitations: 3Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinkedInRedditWechat No abstract is available for this article.Citing Literature Volume5, Issue12December 1979Pages 944-944 RelatedInformation