Dermatologic surgery in children: an update on indication, anesthesia, analgesia and potential perioperative complications

• Published in: Journal der Deutschen Dermatologischen Gesellschaft Vol. 16; no. 3; pp. 268 - 276
• Main Authors: Crisan, Diana, Scharffetter‐Kochanek, Karin, Kastler, Sabine, Crisan, Maria, Manea, Avram, Wagner, Katja, Schneider, Lars Alexander
• Format: Journal Article
• Language: English
• Published: Germany 01.03.2018
• Subjects: Adolescent; Analgesia - adverse effects; Analgesia - methods; Analgesics - adverse effects; Analgesics - pharmacokinetics; Analgesics - therapeutic use; Anesthesia - adverse effects; Anesthesia - methods; Anesthetics - adverse effects; Anesthetics - pharmacokinetics; Anesthetics - therapeutic use; Child; Child, Preschool; Dermatologic Surgical Procedures - methods; Hemangioma - congenital; Hemangioma - surgery; Humans; Infant; Nevus - congenital; Nevus - surgery; Perioperative Care - methods; Port-Wine Stain - surgery; Risk Factors; Skin Diseases - congenital; Skin Diseases - surgery; Skin Neoplasms - congenital; Skin Neoplasms - surgery
• ISSN: 1610-0379; 1610-0387
• DOI: 10.1111/ddg.13451

Summary Background Children undergoing dermatosurgical procedures require, unlike adults, particular attention; the administration of various analgesics, anesthetics or sedatives requires a thorough knowledge of drug pharmacokinetics and pharmacodynamics. Furthermore, there are concerns that drugs used for sedation/general anesthesia may result in anesthetic/analgesic complications in children undergoing surgery, with a risk of impaired mental development. Objectives Based on our clinical experience and a literature review, we illustrate the most commonly used analgesic, anesthetic and sedative drugs in pediatric dermatosurgery, and identify risk factors and complications following dermatosurgical procedures. Results Topical anesthetics can be used in children for superficial dermatologic procedures or prior to infiltration anesthesia. Maximum recommended doses based on body weight should be calculated in order to avoid overdosage of local anesthetics. General anesthesia in dermatosurgery is considered safe and has a low rate of side effects. However, caution is advised in children under the age of one due to potential long‐term neurological side‐effects. NSAIDs and opioids play a significant role in analgesia for children. Conclusions This article reviews currently available data on analgesia, anesthesia and complications that may arise in pediatric dermatosurgery. These data may be useful in optimizing the safety and quality of care and in improving parent counseling.