Anesthesia options for laser...

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Anesthesia options for laser...
Wed, 10-06-2010 - 7:18am

Anesthesia options for laser....Submitted by "mommylamb" Anesthesia Options for Pulsed Laser Treatment of Children

SCHAUMBURG, Ill., Aug. 27, 1997 -- With any surgery, the proper selection of anesthesia is a key factor in successfully controlling pain and minimizing side effects, especially when dealing with children. Port-wine stain or nevus flammeus, is a congenital malformation of the skin reported in 3-5% of newborns, and is most commonly removed with pulsed laser treatment. Often treatment is performed in infancy or early childhood to prevent future growth of the lesion and to remove unwanted skin abnormalities before school age ridicule. Frequently, multiple treatments are necessary to lighten or remove lesions.

In the July issue of the Journal of the American Academy of Dermatology, Joop M. Grevelink, M.D., Massachusetts General Hospital Dermatology Laser Center, Boston, reported the results of a study assessing the safety and side effects of general anesthesia in the treatment of vascular lesions, comparing this to treatment outcomes in the office setting.

"The rationale for choosing certain anesthetic options in children when they are being treated with pulsed lasers should be examined at every step in the laser treatment(s). This study examined the predictive factors, outcomes and complications associated with choosing the office setting with topical and local injections versus the same day surgery unit (SDSU) with general anesthesia," said Dr. Grevelink.

The level of pain or discomfort varies, and is typically tolerated well by adults. However, for infants and children under age 16, treatment of larger areas is often traumatic when done in the doctor's office. Multiple treatments are usually necessary to remove most lesions, and the child may develop progressive fear and opposition to office treatment. The pain of laser treatment may make children more difficult to manage in the office setting, leading to more visits, longer treatment times, or the postponement of treatment until a later age.

The controversy has long existed over the complications of general anesthesia in children. Should a child be subjected to the risks of general anesthesia such as postoperative nausea and vomiting, laryngospasm (breath holding), and potential aspiration pneumonia, or should the patient endure pain, both mental and physical, associated with laser treatment in the office with little or no anesthesia?

"The results of the study show that the benefits of general anesthesia outweigh the risks. General anesthesia was shown to be effective in minimizing the pain and discomfort associated with laser treatment with only minimal aftereffects," reported Dr. Grevelink.

Modern general anesthesia allows safe treatment, reducing the risk of surgical complications such as overlapping laser pulses that can lead to scarring. Treatment is more efficient with fewer complications from unexpected movement and is less time-consuming. In a study of 48 children undergoing 105 laser treatments under general anesthesia, the majority woke up calm and pain-free from treatment.

Office surgery can often be performed efficiently when small lesions are being treated using topical anesthesia. The use of general anesthesia in the treatment of port-wine stains in children does not appear to be accompanied by increased risk. The factors determining the type of anesthesia to use include (1) the age of the patient, (2) the number of treatments necessary, and (3) the size and location of the lesions.

The American Academy of Dermatology is the largest medical society representing physicians who specialize in treating skin, hair and nail conditions.

CONTACT: Donna Stein of The American Academy of Dermatology, 847-330-0101, ext. 341, or e-mail, dstein@aad.org (not sure if the phone and/or e-mail info is still current)