Abstract
Procedures for diagnostic and therapeutic purposes are commonplace in pediatric dermatology practices. Managing children undergoing invasive procedures requires minimizing pain and anxiety during the procedure while meeting the emotional needs of the child and family. As a guiding principle, pediatric dermatologists aim to avoid general anesthesia whenever possible, given the unresolved safety issues surrounding the sedation of young children and the potential risk of neurotoxic effects from anesthetic agents. This chapter reviews options for the safe and effective use of analgesics, sedatives, and anesthetics for the management of children requiring invasive procedures in both the office and outpatient surgical setting. Nonpharmacologic strategies for pain management, used alone or in combination with pharmacologic agents, are offered to avoid unnecessary sedation for procedures that traditionally required general anesthesia in children. This chapter also offers newer surgical techniques and regional anesthetic pearls for minimizing injected and procedure-related pain to be incorporated into your practice.
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Gorgulu T, Torun M, Guler R. Fast and painless skin tag excision with ethyl chloride. Aesth Plast Surg. 2015;39(4):644–5.
Alkhalifah A. Topical and intralesional therapies for alopecia areata. Dermatol Ther. 2011;24(3):355–63.
Braun HJ, Wilcox-Fogel N, Kim HJ, Pouliot MA, Harris AH, Dragoo JL. The effect of local anesthetic and corticosteroid combinations on chondrocyte viability. Knee Surg Sports Traumatol Arthrosc. 2012;20(9):1689–95.
Kuldeep C, Singhal H, Khare AK, Mittal A, Gupta LK, Garg A. Randomized comparison of topical betamethasone valerate foam, intralesional triamcinolone acetonide and tacrolimus ointment in management of localized alopecia areata. Int J Trichol. 2011;3(1):20–4.
Couto JA, Greene AK. Management of problematic infantile hemangioma using intralesional triamcinolone: efficacy and safety in 100 infants. J Plast Reconstr Aesthet Surg. 2014;67(11):1469–74.
Jalil S, Akhtar J, Ahmed S. Corticosteroids therapy in the management of infantile cutaneous hemangiomas. J Coll Phys Surg Pak. 2006;16(10):662–5.
Sadeghinia A, Sadeghinia S. Comparison of the efficacy of intralesional triamcinolone acetonide and 5-fluorouracil tattooing for the treatment of keloids. Dermatol Surg. 2012;38(1):104–9.
Majid I, Imran S. Immunotherapy with intralesional candida albicans antigen in resistant or recurrent warts: a study. Indian J Dermatol. 2013;58(5):360–5.
Lowe N, Campanati A, Bodokh I, Cliff S, Jaen P, Kreyden O, Naumann M, et al. The place of botulinum toxin type A in the treatment of focal hyperhidrosis. Br J Dermatol. 2004;151(6):1115–22.
Burk CJ, Benjamin LT, Connelly EA. Distraction anesthesia for pediatric dermatology procedures. Pediatr Dermatol. 2007;24(4):419–20.
Yoo SS, Liggett J, Cohen BA. Use of parent-child tents in pediatric laser surgery. Dermatol Surg. 2003;29(4):399–401.
Gupta AK, Koren G, Shear NH. A double-blind, randomized, placebo-controlled trial of eutectic lidocaine/prilocaine cream 5 % (EMLA) for analgesia prior to cryotherapy of warts in children and adults. Pediatr Dermatol. 1998;15(2):129–33.
Sorrell J, Carmichael C, Chamlin S. Oral sucrose for pain relief in young infants with hemangiomas treated with intralesional steroids. Pediatr Dermatol. 2010;27(2):154–5.
Richards RN. Ethyl chloride spray for sensory relief for botulinum toxin injections of the hands and feet. J Cutan Med Surg. 2009;13(5):253–6.
Irkoren S, Ozkan HS, Karaca H. A clinical comparison of EMLA cream and ethyl chloride spray application for pain relief of forehead botulinum toxin injection. Ann Plast Surg. 2015;75(3):272–4.
Mallory SB, Lehman PA, Vanderpool DR, Franz TJ. Topical lidocaine for anesthesia in patients undergoing pulsed dye laser treatment for vascular malformations. Pediatr Dermatol. 1993;10(4):370–5.
Wagner AM, Suresh S. Peripheral nerve blocks for warts: taking the cry out of cryotherapy and laser. Pediatr Dermatol. 1998;15(3):238–41.
Stephen MC, Mathew J, Varghese AM, Kurien M, Mathew GA. A randomized controlled trial comparing intranasal midazolam and chloral hydrate for procedural sedation in children. Otolaryngol Head Neck Surg. 2015;153(6):1042–50.
Juern AM, Cassidy LD, Lyon VB. More evidence confirming the safety of general anesthesia in pediatric dermatologic surgery. Pediatr Dermatol. 2010;27(4):355–60.
O’Regan GM, Benjamin LT. Delineating capillary malformations in the operating suite using white eyeliner pencil. Pediatr Dermatol. 2011;28(6):746–7.
Brewer S, Gleditsch SL, Syblik D, Tietjens ME, Vacik HW. Pediatric anxiety: child life intervention in day surgery. J Pediatr Nurs. 2006;21(1):13–22.
Feld LH, Champeau MW, van Steennis CA, Scott JC. Preanesthetic medication in children: a comparison of oral transmucosal fentanyl citrate versus placebo. Anesthesiology. 1989;71(3):374–7.
Vischoff D, Charest J. Propofol for pulsed dye laser treatments in paediatric outpatients. Can J Anaesth. 1994;41(8):728–32.
Howell TK, Smith S, Rushman SC. A comparison of oral transmucosal fentanyl and oral midazolam for premedication in children. Anaesthesia. 2002;57(8):798–805.
Cunningham BB, Gigler V, Wang K, et al. General anesthesia for pediatric dermatologic procedures: risks and complications. Arch Dermatol. 2005;141(5):573–6.
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Benjamin, L.T. (2017). Pearls for Pediatric Dermatologic Procedures. In: Teng, J., Marqueling, A., Benjamin, L. (eds) Therapy in Pediatric Dermatology. Springer, Cham. https://doi.org/10.1007/978-3-319-43630-2_26
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DOI: https://doi.org/10.1007/978-3-319-43630-2_26
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