General Anesthesia for Pediatric Dermatologic Procedures

Cunningham, Bari B.; Gigler, Vishakha; Wang, Kim; Eichenfield, Lawrence F.; Friedlander, Sheila Fallon; Garden, Jerome M.; McFarlane, Samantha; Faierman, Alvin; Wagner, Annette

doi:10.1001/archderm.141.5.573

Cited by 34 publications

(26 citation statements)

References 9 publications

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“…The child with the alopecia recovered fully. The remaining adverse events were relatively minor and self-limited and are consistent with the known adverse events occurring with general anesthetic 50 and BTX-A injection. 28,51 Weakness experienced by 2 participants was prolonged.…”

Section: Discussionsupporting

confidence: 76%

Upper-Limb Botulinum Toxin A Injection and Occupational Therapy in Children With Hemiplegic Cerebral Palsy Identified From a Population Register: A Single-Blind, Randomized, Controlled Trial

et al. 2007

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Section: Discussionsupporting

confidence: 76%

Upper-Limb Botulinum Toxin A Injection and Occupational Therapy in Children With Hemiplegic Cerebral Palsy Identified From a Population Register: A Single-Blind, Randomized, Controlled Trial

et al. 2007

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“…While we advocate excision of NS, as with any elective operation, there are risks that must be considered and conveyed to the parents and patient, such as the risks associated with general anesthesia. The overall risk of an anesthetic complication for a healthy child according to the American Society of Anesthesiologists (ASA) guidelines is between 1:20,000 and1:80,000 (20). In 2005, a study of 881 dermatologic procedures under general anesthesia in children without comorbidities revealed a mortality rate of 0%, and while 97% of cases had no clinically relevant complications, 19% of patients did exhibit asymptomatic bradycardia, 4% of patients experienced perioperative nausea and emesis, and 0.8% had laryngospasm (20).…”

Section: Discussionmentioning

confidence: 99%

“…The overall risk of an anesthetic complication for a healthy child according to the American Society of Anesthesiologists (ASA) guidelines is between 1:20,000 and1:80,000 (20). In 2005, a study of 881 dermatologic procedures under general anesthesia in children without comorbidities revealed a mortality rate of 0%, and while 97% of cases had no clinically relevant complications, 19% of patients did exhibit asymptomatic bradycardia, 4% of patients experienced perioperative nausea and emesis, and 0.8% had laryngospasm (20). In addition, the patient's medical history must be taken into consideration when deciding to perform an elective excision under general anesthesia.…”

Section: Discussionmentioning

confidence: 99%

Management of Nevus Sebaceous and the Risk of Basal Cell Carcinoma: An 18‐Year Review

Rosen

Schmidt

Lam

et al. 2009

Pediatric Dermatology

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Nevus sebaceous (NS) is a common congenital hamartoma of the skin, usually found on the head and neck. It may undergo malignant transformation to basal cell carcinoma (BCC). However the incidence and lifetime risk of malignant transformation is unknown. We performed an 18-year review of all NS excisions at our institution, to report the number of cases of BCC and other neoplasms within excised NS. The aim is to inform physicians who must weigh the risks in recommending excision of a NS in a pediatric patient population with the risk of malignancy. After a database query for years 1990-2008, charts were reviewed and data were extracted on demographics and surgical history relating to NS. Thirty-one NS with abnormal findings were reviewed microscopically by a dermatopathologist. There were 651 NS distinct lesions among 631 patients and 690 excisions. Twenty-one intralesional diagnoses were found in 18 patients. Five patients (0.8%) had BCC (mean age 12.5 yrs, range 9.7-17.4 yrs). Seven (1.1%) had syringocystadenoma papilliferum (SP) (mean age 8.8 yrs, range 1.7-16.9 yrs), a lesion that may undergo malignant transformation. Malignant transformation of NS can occur in childhood or adolescence. We believe all NS should be excised, however timing of excision can be flexible. Our data do not support age cutoffs or morphologic changes to determine optimal excision time. In conjunction with the treating physician, the parent and patient may weigh the small risk of malignant transformation of NS against the morbidity associated with excision and anesthesia.Nevus sebaceous (NS) is a congenital skin lesion commonly seen by pediatricians, dermatologists, and plastic surgeons. It occurs in fewer than 1% of neonates, and was first described by Jadassohn in 1895 (1). Nevus sebaceous is a congenital hamartoma of the skin, defined by hyperplasia of the epidermis, hair follicles, and sebaceous and apocrine glands. It manifests in infancy as a raised, finely papulated alopecic plaque that is usually Address correspondence to Brian I.

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“…Age should not be an issue to start treatment; with advances in anesthesia and surgical technique, surgery may be started even earlier than 6 months of age. 21 In a study that explored the risk of MM development and compared this to both the risks of anesthesia and psychosocial factors associated with living with a large nevus, the optimum time for surgical excision was between 6 and 9 months of age. 22 Treatment cannot eliminate the risk of developing MM because it may not be possible or unrealistic to remove every nevus cell.…”

mentioning

confidence: 99%

Large congenital melanocytic nevi, risk of cutaneous melanoma, and prophylactic surgery

Marghoob¹,

Agero²,

Benvenuto-Andrade³

et al. 2006

Journal of the American Academy of Dermatology

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General Anesthesia for Pediatric Dermatologic Procedures

Cited by 34 publications

References 9 publications

Upper-Limb Botulinum Toxin A Injection and Occupational Therapy in Children With Hemiplegic Cerebral Palsy Identified From a Population Register: A Single-Blind, Randomized, Controlled Trial

Upper-Limb Botulinum Toxin A Injection and Occupational Therapy in Children With Hemiplegic Cerebral Palsy Identified From a Population Register: A Single-Blind, Randomized, Controlled Trial

Management of Nevus Sebaceous and the Risk of Basal Cell Carcinoma: An 18‐Year Review

Large congenital melanocytic nevi, risk of cutaneous melanoma, and prophylactic surgery

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