Risk analysis of systemic side effects of tumescent local anaesthesia in the surgical treatment of geriatric and multimorbid patients with skin cancer

Risk analysis of systemic side effects of tumescent local anaesthesia in the surgical treatment of geriatric and multimorbid patients with skin cancer

Background Due to demographic change and increased UV exposure, the number of dermatosurgical procedures in the elderly is increasing. Data on the occurrence of systemic side effects during and after treatment with tumescent local anaesthesia are limited and do not refer to details such as volume an...

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Veröffentlicht in:Journal of the European Academy of Dermatology and Venereology 2023-01, Vol.37 (1), p.65-74
Hauptverfasser: Schnabl, Saskia Maria, Garbe, Claus, Breuninger, Helmut, Walter, Vincent, Aebischer, Valentin, Eckardt, Julia, Ghoreschi, Franziska Carola, Häfner, Hans‐Martin, Scheu, Alexander
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container_issue 1
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container_title Journal of the European Academy of Dermatology and Venereology
container_volume 37
creator Schnabl, Saskia Maria
Garbe, Claus
Breuninger, Helmut
Walter, Vincent
Aebischer, Valentin
Eckardt, Julia
Ghoreschi, Franziska Carola
Häfner, Hans‐Martin
Scheu, Alexander
description Background Due to demographic change and increased UV exposure, the number of dermatosurgical procedures in the elderly is increasing. Data on the occurrence of systemic side effects during and after treatment with tumescent local anaesthesia are limited and do not refer to details such as volume and composition of local anaesthetics or epinephrine additive. Objectives The aim of this study was to investigate the risk of systemic side effects in elderly patients undergoing skin tumour surgery with tumescent local anaesthesia. Methods Investigation of systemic complications in patients (≥75 years) who underwent head and neck skin tumour surgery under tumescent local anaesthesia at the Department of Dermatology, University Medical Centre Tübingen, between October 2018 and March 2020. Results In total 782 patients (479 males, 303 females) with a mean age of 83.3 years (range: 75.1–102.2 years) could be included. A total of 2940 procedures were performed. Patients were assigned to two groups. The old–old group (≥75–84 years) included 491 patients and the oldest–old group (≥85 years) included 291 patients. The total inpatient stay and thus mean follow‐up period was 4.9 days (range 1–28 days). 92.0% (719/782) suffered from pre‐existing comorbidities. Systemic complications occurred in 10.2% (80/782; old–olds: 8.6%, oldest–olds: 13.1%). Hypertensive crisis (>180/120 mmHg) requiring intervention (6.7%) that occurred intraoperatively or during the inpatient stay was the most frequent systemic complication. Cardiac arrhythmias occurred postoperatively in 0.8% of cases. No life‐threatening complications directly related to tumescent local anaesthesia were found. Conclusions Skin tumour surgery in tumescent local anaesthesia for the elderly is safe, and complications caused by general anaesthesia can be avoided. Systemic complications can occur, but are usually mild, are caused by pre‐existing diseases and perioperative excitement, and can be rapidly detected and well treated by monitoring. There is no direct correlation of complications to high‐tumescent concentrations or volume quantities.
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Data on the occurrence of systemic side effects during and after treatment with tumescent local anaesthesia are limited and do not refer to details such as volume and composition of local anaesthetics or epinephrine additive. Objectives The aim of this study was to investigate the risk of systemic side effects in elderly patients undergoing skin tumour surgery with tumescent local anaesthesia. Methods Investigation of systemic complications in patients (≥75 years) who underwent head and neck skin tumour surgery under tumescent local anaesthesia at the Department of Dermatology, University Medical Centre Tübingen, between October 2018 and March 2020. Results In total 782 patients (479 males, 303 females) with a mean age of 83.3 years (range: 75.1–102.2 years) could be included. A total of 2940 procedures were performed. Patients were assigned to two groups. The old–old group (≥75–84 years) included 491 patients and the oldest–old group (≥85 years) included 291 patients. The total inpatient stay and thus mean follow‐up period was 4.9 days (range 1–28 days). 92.0% (719/782) suffered from pre‐existing comorbidities. Systemic complications occurred in 10.2% (80/782; old–olds: 8.6%, oldest–olds: 13.1%). Hypertensive crisis (&gt;180/120 mmHg) requiring intervention (6.7%) that occurred intraoperatively or during the inpatient stay was the most frequent systemic complication. Cardiac arrhythmias occurred postoperatively in 0.8% of cases. No life‐threatening complications directly related to tumescent local anaesthesia were found. Conclusions Skin tumour surgery in tumescent local anaesthesia for the elderly is safe, and complications caused by general anaesthesia can be avoided. Systemic complications can occur, but are usually mild, are caused by pre‐existing diseases and perioperative excitement, and can be rapidly detected and well treated by monitoring. There is no direct correlation of complications to high‐tumescent concentrations or volume quantities.</description><identifier>ISSN: 0926-9959</identifier><identifier>EISSN: 1468-3083</identifier><identifier>DOI: 10.1111/jdv.18588</identifier><identifier>PMID: 36152007</identifier><language>eng</language><publisher>England</publisher><ispartof>Journal of the European Academy of Dermatology and Venereology, 2023-01, Vol.37 (1), p.65-74</ispartof><rights>2022 The Authors. published by John Wiley &amp; Sons Ltd on behalf of European Academy of Dermatology and Venereology.</rights><rights>2022 The Authors. 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Data on the occurrence of systemic side effects during and after treatment with tumescent local anaesthesia are limited and do not refer to details such as volume and composition of local anaesthetics or epinephrine additive. Objectives The aim of this study was to investigate the risk of systemic side effects in elderly patients undergoing skin tumour surgery with tumescent local anaesthesia. Methods Investigation of systemic complications in patients (≥75 years) who underwent head and neck skin tumour surgery under tumescent local anaesthesia at the Department of Dermatology, University Medical Centre Tübingen, between October 2018 and March 2020. Results In total 782 patients (479 males, 303 females) with a mean age of 83.3 years (range: 75.1–102.2 years) could be included. A total of 2940 procedures were performed. Patients were assigned to two groups. The old–old group (≥75–84 years) included 491 patients and the oldest–old group (≥85 years) included 291 patients. The total inpatient stay and thus mean follow‐up period was 4.9 days (range 1–28 days). 92.0% (719/782) suffered from pre‐existing comorbidities. Systemic complications occurred in 10.2% (80/782; old–olds: 8.6%, oldest–olds: 13.1%). Hypertensive crisis (&gt;180/120 mmHg) requiring intervention (6.7%) that occurred intraoperatively or during the inpatient stay was the most frequent systemic complication. Cardiac arrhythmias occurred postoperatively in 0.8% of cases. No life‐threatening complications directly related to tumescent local anaesthesia were found. Conclusions Skin tumour surgery in tumescent local anaesthesia for the elderly is safe, and complications caused by general anaesthesia can be avoided. Systemic complications can occur, but are usually mild, are caused by pre‐existing diseases and perioperative excitement, and can be rapidly detected and well treated by monitoring. 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Data on the occurrence of systemic side effects during and after treatment with tumescent local anaesthesia are limited and do not refer to details such as volume and composition of local anaesthetics or epinephrine additive. Objectives The aim of this study was to investigate the risk of systemic side effects in elderly patients undergoing skin tumour surgery with tumescent local anaesthesia. Methods Investigation of systemic complications in patients (≥75 years) who underwent head and neck skin tumour surgery under tumescent local anaesthesia at the Department of Dermatology, University Medical Centre Tübingen, between October 2018 and March 2020. Results In total 782 patients (479 males, 303 females) with a mean age of 83.3 years (range: 75.1–102.2 years) could be included. A total of 2940 procedures were performed. Patients were assigned to two groups. The old–old group (≥75–84 years) included 491 patients and the oldest–old group (≥85 years) included 291 patients. The total inpatient stay and thus mean follow‐up period was 4.9 days (range 1–28 days). 92.0% (719/782) suffered from pre‐existing comorbidities. Systemic complications occurred in 10.2% (80/782; old–olds: 8.6%, oldest–olds: 13.1%). Hypertensive crisis (&gt;180/120 mmHg) requiring intervention (6.7%) that occurred intraoperatively or during the inpatient stay was the most frequent systemic complication. Cardiac arrhythmias occurred postoperatively in 0.8% of cases. No life‐threatening complications directly related to tumescent local anaesthesia were found. Conclusions Skin tumour surgery in tumescent local anaesthesia for the elderly is safe, and complications caused by general anaesthesia can be avoided. Systemic complications can occur, but are usually mild, are caused by pre‐existing diseases and perioperative excitement, and can be rapidly detected and well treated by monitoring. 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title Risk analysis of systemic side effects of tumescent local anaesthesia in the surgical treatment of geriatric and multimorbid patients with skin cancer
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