Pediatric surgical pearls: minimizing complications

Risk of General Anesthesia in Pediatric Skin Procedures with Projection on Tumescent Anesthesia

Background

Uses of general anaesthesia in outpatient invasive procedures have increased, especially in dermatology. Being uncooperative, children often require general anaesthesia, since surgical skin operations are mostly painful.

Aim

The purpose of this study is to evaluate the safety, significant adverse events, and the complication rates related to general anaesthesia, when used among pediatric population undergoing skin procedures.

Methods

We conducted a first retrospective cohort study of patient chart review during the period from September 1, 2017 through September 2019. All patients admitted for pediatric skin procedures during this period have participated in our study. We reviewed selected charts to document any unexpected admissions, adverse events, or complications. Surgical outcomes and anaesthesia complications were reviewed by three anesthesiologists. We assessed inter-rater reliability.

Results

A total of 211 procedures were reported for 211 patients with 19 diagnoses. No adverse events related to anaesthesia were recognized, apart from minor complications noticed in twelve patients. The kappa value range is between 0.78 and 1.00 (95% C.I., 0.46809 to 1.00).

Conclusion

Dermatologist and pediatricians can safely do necessary procedures under general anaesthesia with the supervision of pediatric-trained anesthesiologists while considering other safety and risk precautions and the pediatric age group.

Local anesthesia in pediatric dermatologic surgery: Evaluation of a patient-centered approach

BACKGROUND/OBJECTIVES

A few studies have documented the effect of local anesthesia for minor dermatologic surgical procedures on children and their parents. Our objective was to evaluate the psychological effect and global satisfaction of a patient-centered approach to dermatologic surgery under local anesthesia.

METHODS

Two self-administered questionnaires were used to evaluate the distress and global satisfaction of 388 children who underwent dermatologic surgery under local anesthesia, accompanied by oral and written therapeutic education measures (structured information and a cartoon brochure illustrating the procedure) addressed to children and parents. Distraction techniques were also used during the procedures.

RESULTS

Although 54.5% of patients manifested some degree of fear, all other parameters analyzed (pain, surgery-related distress, surgical team-patient and -family relationship, global satisfaction) indicated that the procedures resulted in limited distress and that the large majority of children and parents tolerated them well.

CONCLUSION

Specific measures for therapeutic pediatric patient education may be helpful in limiting discomfort, anxiety, and pain perception linked to procedures performed under local anesthesia. Further controlled studies are required to more precisely assess the benefits of specific therapeutic education measures.

[Special aspects of dermatologic surgery in children]

This reviews gives suggestions how to meet the needs of our young patients, especially with reference to dermatologic surgery. With the right attitude, specific knowledge and appropriate preparation, a potential disruption can be transformed into a low-conflict routine or even a rewarding experience for all persons involved.

More evidence confirming the safety of general anesthesia in pediatric dermatologic surgery

Outpatient surgical procedures performed in medicine have been increasing, as has the use of general anesthesia. Children are more likely to require general anesthesia for procedures because of developmental constraints limiting their cooperation. Dermatology procedures are typically painful and can require time to perform and thus necessitating the use of general anesthesia. Studies evaluating safety and complication rates associated with the use of general anesthesia in children are needed to determine the safety of this practice. The purpose of this investigation was to assess whether the use of general anesthesia to perform pediatric dermatology surgical procedures was associated with any significant adverse events. A retrospective chart review was conducted for eligible patients with a procedure code in the range of 10,040-19,499 for a period of 2 years. Records were reviewed for documentation of any unplanned visits, events or complications. A total of 681 procedures were reported for 226 unique patients with 235 diagnoses. No anesthesia-related adverse events were identified in any of these patients. Eleven patients had documentation of minor complications of the wound. General anesthesia can be used safely in pediatric dermatology surgery patients without associated complications in the appropriate setting, indication, and patient population, using state-of-art technology and equipment, and experienced pediatric-trained anesthesiologists.

Small and medium-sized congenital nevi in children: a comparison of the costs of excision and long-term follow-up

BACKGROUND

Clinical decisions on whether to follow up or remove small and medium congenital melanocytic nevi (SMCMN) in children have cost implications that have not been studied.

OBJECTIVES

To compare the costs of excision of SMCMN in children with lifelong follow-up in a tertiary center.

METHODS AND MATERIALS

We elaborated models for the evaluation of the costs of excision and long-term follow-up. We retrospectively collected data on 113 consecutive excised SMCMN (105 single-step interventions and 8 multiple-step interventions) from the medical records of our pediatric dermatology unit from 2001 to 2007 and calculated and compared the costs (direct and indirect) of surgery and follow-up.

RESULTS

The mean +/- standard deviation and total cohort costs for single-step interventions were euro 1,504.73 +/- 198.33 and 157,996.20, respectively. Median and cohort lifelong follow-up costs were similar if performed every 4 years (1,482.66 +/- 34.98 and 156,679.63). For multiple-step interventions (3 or 4 steps), surgery costs were similar to those of annual lifelong follow-up. In the case of two-step surgery, costs were similar to lifelong follow-up every 2 years.

CONCLUSIONS

An analysis of the costs of surgery and long-term follow-up in children with SMCMN is possible. Although the clinical judgment of the dermatologist and parental opinion are the main determinants in the management of SMCMN, costs should also be taken into account.