Department of Dermatology and Allergic Diseases, University Clinic Ulm, Germany.
Department of Dermatology, University of Medicine and Pharmacy "Iuliu Hatieganu", Cluj-Napoca, Romania.
J Dtsch Dermatol Ges. 2018 Mar;16(3):268-276. doi: 10.1111/ddg.13451. Epub 2018 Feb 12.
Children undergoing dermatosurgical procedures require, unlike adults, particular attention; the administration of various analgesics, anesthetics or sedatives requires a thorough knowledge of drug pharmacokinetics and pharmacodynamics. Furthermore, there are concerns that drugs used for sedation/general anesthesia may result in anesthetic/analgesic complications in children undergoing surgery, with a risk of impaired mental development.
Based on our clinical experience and a literature review, we illustrate the most commonly used analgesic, anesthetic and sedative drugs in pediatric dermatosurgery, and identify risk factors and complications following dermatosurgical procedures.
Topical anesthetics can be used in children for superficial dermatologic procedures or prior to infiltration anesthesia. Maximum recommended doses based on body weight should be calculated in order to avoid overdosage of local anesthetics. General anesthesia in dermatosurgery is considered safe and has a low rate of side effects. However, caution is advised in children under the age of one due to potential long-term neurological side-effects. NSAIDs and opioids play a significant role in analgesia for children.
This article reviews currently available data on analgesia, anesthesia and complications that may arise in pediatric dermatosurgery. These data may be useful in optimizing the safety and quality of care and in improving parent counseling.
与成年人不同，接受皮肤科手术的儿童需要特别关注；各种镇痛药、麻醉剂或镇静剂的给药需要对药物药代动力学和药效学有透彻的了解。此外，人们担心用于镇静/全身麻醉的药物可能会导致接受手术的儿童出现麻醉/镇痛并发症，从而有损害精神发育的风险。
基于我们的临床经验和文献复习，我们阐述了在儿童皮肤科手术中最常使用的镇痛、麻醉和镇静药物，并确定了皮肤科手术后的风险因素和并发症。
局部麻醉剂可用于儿童进行浅表皮肤病学操作或浸润麻醉之前。为避免局部麻醉剂过量，应根据体重计算最大推荐剂量。全身麻醉在皮肤科手术中被认为是安全的，且副作用发生率低。然而，由于潜在的长期神经副作用，建议谨慎用于一岁以下的儿童。非甾体抗炎药和阿片类药物在儿童镇痛中起着重要作用。
本文综述了目前可用于儿科皮肤科手术的镇痛、麻醉和可能出现的并发症的数据。这些数据可能有助于优化安全性和护理质量，并改善家长咨询。
