Dermatologic Surgery and the Pregnant Patient

Abstract

background. Because of concerns about potential harm to the mother or fetus, dermatologic surgeons are frequently hesitant to perform cutaneous surgery on pregnant patients. objective. To review the relevant physiologic changes during pregnancy, appropriate preparation for and timing of procedures, and drug safety. methods. A literature review was performed of dermatologic and nondermatologic journals discussing physiology, surgery, and drug safety in the pregnant patient. results. Special positioning is required for the pregnant patient during surgery. Low doses of most local anesthetics with epinephrine as well as nitrous oxide less than 50% are safe to use during pregnancy. Sedatives and opioids are potential teratogens and should be avoided. Safe antibiotics to use during skin surgery in pregnancy include penicillins, cephalosporins, and nonestolate erythromycin. If necessary, lymph node dissections under general anesthesia in the pregnant melanoma patient should occur during the second trimester. conclusion. With appropriate preparation, safe and successful cutaneous surgery can be performed on the pregnant patient. Respiratory ChangesBy term, there is an increase in tidal volume and minute respiration to 30-40% due to increased fetal K.A. Richards, MD and T. Stasko, MD have indicated no significant interest with commercial supporters.

A review of the safety of cosmetic procedures during pregnancy and lactation

“…The main concerns when using injectable anesthetic drugs in patients who are pregnant include the amount of placental transfer and possibility of teratogenicity (Richards and Stasko, 2002). Heinonen et al (1977) demonstrated the relative safety of lidocaine, benzocaine, propoxycaine, and tetracaine use during the first trimester of a pregnancy in a study that reported no increase in the rate of birth anomalies for 293 women.…”

“…Concerns arise from the serious risk of uterine artery spasms with the administration of increased doses of epinephrine. However, the doses that are used in dermatologic surgeries are relatively low and have not been causally associated with this side effect (Richards and Stasko, 2002). …”

“…The results of this study labeled bupivacaine and mepivacaine as category C drugs because of concerns of fetal bradycardia and preterm labor in the case of mepivacaine use (Moore, 1998, Richards and Stasko, 2002). …”

A Review of the Safety of Common Aesthetic Procedures during Pregnancy

“…Increased precaution is therefore needed to prevent infection, including hand washing, gloving and appropriate skin preparation. Iodine and Hexachlorophene are both contraindicated in pregnancy due to thyroid and central nervous system toxicity, respectively [5]. Therefore, alcohol or Chlorhexidine gluconate solutions should be used to achieve sterility of the procedure site.…”

“…The major risks from using lidocaine come from high-dose exposure or accidental arterial injection, both of which could theoretically lead to foetal cardiac or central nervous system toxicity [5]. However, the maximum safe injectable dose of lidocaine is 4.5mg/kg, up to a maximum of 300mg, which is well below the typical amount used for aesthetic procedures.…”