ANESTHESIA MANAGEMENT IN DERMATOLOGICAL SURGERY: TECHNIQUES, CHALLENGES, AND COMPLICATIONS
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Keywords
Dermatological surgery, Local anesthesia, Tumescent local anesthesia (TLA), Regional nerve block, Office-based surgery, Ambulatory surgery, Conscious sedation, Intravenous sedation, Dexmedetomidine, Propofol, Midazolam, Local anesthetic systemic toxicity (LAST), Lidocaine toxicity, Patient safety, Perioperative anesthesia, Liposuction, Mohs micrographic surgery, Pain management, Airway management, Dermatologic anesthesia
Abstract
Background: Dermatological surgery has transitioned significantly from hospital operating theaters to office-based settings and ambulatory surgical centers. This shift requires anesthesia providers and dermatologic surgeons to possess a nuanced understanding of specialized anesthetic techniques tailored to diverse procedures, ranging from micrographic skin cancer excisions to extensive body-contouring liposuctions.
Objective: This comprehensive review synthesizes current anesthetic modalities utilized in dermatological surgery, evaluates procedural and patient-specific challenges, analyzes potential localized and systemic complications, and establishes evidence-based mitigation protocols.
Methods: A systematic review of contemporary literature regarding local anesthesia, regional nerve blocks, tumescent local anesthesia (TLA), and intravenous conscious sedation in dermatological subspecialties was performed. Extracted parameters focused on safety thresholds, drug toxicity dynamics, patient comorbidities, and adverse event management.
Results: Local and regional techniques remain the foundation of dermatological anesthesia, offering excellent targeted pain control with minimal systemic impact. Tumescent local anesthesia allows large-scale interventions (e.g., liposuction) without general anesthesia, though it introduces a risk of delayed lidocaine toxicity due to slow systemic absorption. Intravenous sedation options, such as dexmedetomidine, propofol, and midazolam, enhance patient compliance during long or high-anxiety procedures but necessitate strict airway monitoring. Key challenges include operating on elderly patients with extensive cardiovascular or pulmonary comorbidities and navigating complex facial anatomy. Primary complications range from benign vasovagal episodes to severe Local Anesthetic Systemic Toxicity (LAST) and epinephrine-induced hypertensive crises.
Conclusion: Anesthesia management in dermatological surgery demands a precise, patient-centric approach that balances surgical access with patient safety. By implementing strict weight-based dosing, keeping lipid emulsion rescue therapies readily available, and utilizing proper patient positioning, clinicians can effectively minimize risks and optimize outcomes in ambulatory and office-based settings.
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