Semin Plast Surg 2012; 26(03): 117-124
DOI: 10.1055/s-0032-1329416
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Anesthesia Methods in Laser Resurfacing

Sergio Gaitan
1   Department of Dermatology, Baylor College of Medicine, Houston, Texas
,
Ramsey Markus
1   Department of Dermatology, Baylor College of Medicine, Houston, Texas
› Author Affiliations
Further Information

Publication History

Publication Date:
01 November 2012 (online)

Abstract

Laser resurfacing technology offers the ability to treat skin changes that are the result of the aging process. One of the major drawbacks of laser resurfacing technologies is the pain associated with the procedure. The methods of anesthesia used in laser resurfacing to help minimize the pain include both noninvasive and invasive procedures. The noninvasive procedures can be divided into topical, cryoanesthesia, and a combination of both. The invasive methods of anesthesia include injected forms (infiltrative, nerve blocks, and tumescent anesthesia) and supervised anesthesia (monitored anesthesia care and general anesthesia). In this review, the authors summarize the types of anesthesia used in laser resurfacing to aid the provider in offering the most appropriate method for the patient to have as painless a procedure as possible.

 
  • References

  • 1 Rosenthal KJ. Anesthesia for skin rejuvenation. Ophthalmol Clin North Am 1998; 11 (1) 207-217
  • 2 Mehra P, Caiazzo A, Maloney P. Lidocaine toxicity. Anesth Prog 1998; 45 (1) 38-41
  • 3 Goodwin DP, McMeekin TO. A case of lidocaine absorption from topical administration of 40% lidocaine cream. J Am Acad Dermatol 1999; 41 (2 Pt 1) 280-281
  • 4 Rincon E, Baker RL, Iglesias AJ, Duarte AM. CNS toxicity after topical application of EMLA cream on a toddler with molluscum contagiosum. Pediatr Emerg Care 2000; 16 (4) 252-254
  • 5 Brosh-Nissimov T, Ingbir M, Weintal I, Fried M, Porat R. Central nervous system toxicity following topical skin application of lidocaine. Eur J Clin Pharmacol 2004; 60 (9) 683-684
  • 6 Hahn IH, Hoffman RS, Nelson LS. EMLA-induced methemoglobinemia and systemic topical anesthetic toxicity. J Emerg Med 2004; 26 (1) 85-88
  • 7 Marra DE, Yip D, Fincher EF, Moy RL. Systemic toxicity from topically applied lidocaine in conjunction with fractional photothermolysis. Arch Dermatol 2006; 142 (8) 1024-1026
  • 8 Shelley WB. The razor blade in dermatologic practice. Cutis 1975; 16: 843-845
  • 9 Juhlin L, Evers H, Broberg F. A lidocaine-prilocaine cream for superficial skin surgery and painful lesions. Acta Derm Venereol 1980; 60 (6) 544-546
  • 10 Rosdahl I, Edmar B, Gisslén H, Nordin P, Lillieborg S. Curettage of Molluscum contagiosum in children: analgesia by topical application of a lidocaine/prilocaine cream (EMLA). Acta Derm Venereol 1988; 68 (2) 149-153
  • 11 Gupta AK, Sibbald RG. Eutectic lidocaine/prilocaine 5% cream and patch may provide satisfactory analgesia for excisional biopsy or curettage with electrosurgery of cutaneous lesions. A randomized, controlled, parallel group study. J Am Acad Dermatol 1996; 35 (3 Pt 1) 419-423
  • 12 Guardiano RA, Norwood CW. Direct comparison of EMLA versus lidocaine for pain control in Nd:YAG 1,064.  nm laser hair removal. Dermatol Surg 2005; 31 (4) 396-398
  • 13 Kuperman-Beade M, Levine VJ, Ashinoff R. Laser removal of tattoos. Am J Clin Dermatol 2001; 2 (1) 21-25
  • 14 Ashinoff R, Geronemus RG. Effect of the topical anesthetic EMLA on the efficacy of pulsed dye laser treatment of port-wine stains. J Dermatol Surg Oncol 1990; 16 (11) 1008-1011
  • 15 Sherwood KA. The use of topical anesthesia in removal of port-wine stains in children. J Pediatr 1993; 122 (5 Pt 2) S36-S40
  • 16 McCafferty DF, Woolfson AD, Handley J, Allen G. Effect of percutaneous local anaesthetics on pain reduction during pulse dye laser treatment of portwine stains. Br J Anaesth 1997; 78 (3) 286-289
  • 17 Alster TS, Lupton JR. Evaluation of a novel topical anesthetic agent for cutaneous laser resurfacing: a randomized comparison study. Dermatol Surg 2002; 28 (11) 1004-1006 , discussion 1006
  • 18 Alster TS, Tanzi EL, Lazarus M. The use of fractional laser photothermolysis for the treatment of atrophic scars. Dermatol Surg 2007; 33 (3) 295-299
  • 19 Bogle MA, Arndt KA, Dover JS. Evaluation of plasma skin regeneration technology in low-energy full-facial rejuvenation. Arch Dermatol 2007; 143 (2) 168-174
  • 20 Wanner M, Tanzi EL, Alster TS. Fractional photothermolysis: treatment of facial and nonfacial cutaneous photodamage with a 1,550-nm erbium-doped fiber laser. Dermatol Surg 2007; 33 (1) 23-28
  • 21 Goel A, Krupashankar DS, Aurangabadkar S, Nischal KC, Omprakash HM, Mysore V. Fractional lasers in dermatology—current status and recommendations. Indian J Dermatol Venereol Leprol 2011; 77 (3) 369-379
  • 22 Singer AJ, Shallat J, Valentine SM, Doyle L, Sayage V, Thode Jr HC. Cutaneous tape stripping to accelerate the anesthetic effects of EMLA cream: a randomized, controlled trial. Acad Emerg Med 1998; 5 (11) 1051-1056
  • 23 Yun PL, Tachihara R, Anderson RR. Efficacy of erbium:yttrium-aluminum-garnet laser-assisted delivery of topical anesthetic. J Am Acad Dermatol 2002; 47 (4) 542-547
  • 24 Liu DR, Kirchner HL, Petrack EM. Does using heat with eutectic mixture of local anesthetic cream shorten analgesic onset time? A randomized, placebo-controlled trial. Ann Emerg Med 2003; 42 (1) 27-33
  • 25 Irsfeld S, Klement W, Lipfert P. Dermal anaesthesia: comparison of EMLA cream with iontophoretic local anaesthesia. Br J Anaesth 1993; 71 (3) 375-378
  • 26 Railan D, Alster TS. Use of topical lidocaine for cosmetic dermatologic procedures. J Drugs Dermatol 2007; 6 (11) 1104-1108
  • 27 Kundu S, Achar S. Principles of office anesthesia: part II. Topical anesthesia. Am Fam Physician 2002; 66 (1) 99-102
  • 28 Foldvari M, Gesztes A, Mezei M. Dermal drug delivery by liposome encapsulation: clinical and electron microscopic studies. J Microencapsul 1990; 7 (4) 479-489
  • 29 Gillet A, Compère P, Lecomte F , et al. Liposome surface charge influence on skin penetration behaviour. Int J Pharm 2011; 411 (1-2) 223-231
  • 30 Tadicherla S, Berman B. Percutaneous dermal drug delivery for local pain control. Ther Clin Risk Manag 2006; 2 (1) 99-113
  • 31 Bjerring P, Arendt-Nielsen L. Depth and duration of skin analgesia to needle insertion after topical application of EMLA cream. Br J Anaesth 1990; 64 (2) 173-177
  • 32 Evers H, von Dardel O, Juhlin L, Ohlsén L, Vinnars E. Dermal effects of compositions based on the eutectic mixture of lignocaine and prilocaine (EMLA). Studies in volunteers. Br J Anaesth 1985; 57 (10) 997-1005
  • 33 Wahlgren CF, Quiding H. Depth of cutaneous analgesia after application of a eutectic mixture of the local anesthetics lidocaine and prilocaine (EMLA cream). J Am Acad Dermatol 2000; 42 (4) 584-588
  • 34 Chen BK, Eichenfield LF. Pediatric anesthesia in dermatologic surgery: when hand-holding is not enough. Dermatol Surg 2001; 27 (12) 1010-1018
  • 35 Tahir A, Webb JB, Allen G, Nancarrow JD. The effect of local anaesthetic cream (EMLA) applied with an occlusive dressing on skin thickness. Does it matter?. J Plast Reconstr Aesthet Surg 2006; 59 (4) 404-408
  • 36 Bjerring P, Andersen PH, Arendt-Nielsen L. Vascular response of human skin after analgesia with EMLA cream. Br J Anaesth 1989; 63 (6) 655-660
  • 37 Waton J, Boulanger A, Trechot PH, Schmutz JL, Barbaud A. Contact urticaria from Emla cream. Contact Dermat 2004; 51 (5-6) 284-287
  • 38 Ismail F, Goldsmith PC. EMLA cream-induced allergic contact dermatitis in a child with thalassaemia major. Contact Dermat 2005; 52 (2) 111
  • 39 van den Hove J, Decroix J, Tennstedt D, Lachapelle JM. Allergic contact dermatitis from prilocaine, one of the local anaesthetics in EMLA cream. Contact Dermat 1994; 30 (4) 239
  • 40 Eichenfield LF, Funk A, Fallon-Friedlander S, Cunningham BB. A clinical study to evaluate the efficacy of ELA-Max (4% liposomal lidocaine) as compared with eutectic mixture of local anesthetics cream for pain reduction of venipuncture in children. Pediatrics 2002; 109 (6) 1093-1099
  • 41 Friedman PM, Fogelman JP, Nouri K, Levine VJ, Ashinoff R. Comparative study of the efficacy of four topical anesthetics. Dermatol Surg 1999; 25 (12) 950-954
  • 42 Sobanko JF, Miller CJ, Alster TS. Topical anesthetics for dermatologic procedures: a review. Dermatol Surg 2012; 38 (5) 709-721
  • 43 FDA; Warns five firms to stop compounding topical anesthetic creams. Food and Drug Administration; Washington, DC: 2006
  • 44 Kilmer SL, Chotzen V, Zelickson BD , et al. Full-face laser resurfacing using a supplemented topical anesthesia protocol. Arch Dermatol 2003; 139 (10) 1279-1283
  • 45 Olkkola KT, Ahonen J. Midazolam and other benzodiazepines. Handb Exp Pharmacol 2008; 182 (182) 335-360
  • 46 Amin SP, Goldberg DJ. Topical anesthetics for cosmetic and laser dermatology. J Drugs Dermatol 2005; 4 (4) 455-461
  • 47 van Gemert MJ, Welch AJ, Amin AP. Is there an optimal laser treatment for port wine stains?. Lasers Surg Med 1986; 6: 76-83
  • 48 Altshuler GB, Zenzie HH, Erofeev AV, Smirnov MZ, Anderson RR, Dierickx C. Contact cooling of the skin. Phys Med Biol 1999; 44 (4) 1003-1023
  • 49 Chess C, Chess Q. Cool laser optics treatment of large telangiectasia of the lower extremities. J Dermatol Surg Oncol 1993; 19 (1) 74-80
  • 50 Gilchrest BA, Rosen S, Noe JM. Chilling port wine stains improves the response to argon laser therapy. Plast Reconstr Surg 1982; 69 (2) 278-283
  • 51 Kelly KM, Nelson JS, Lask GP, Geronemus RG, Bernstein LJ. Cryogen spray cooling in combination with nonablative laser treatment of facial rhytides. Arch Dermatol 1999; 135 (6) 691-694
  • 52 Tiel H, Drosner M, Hebel T, Raulin C. New cooling technique for pulsed lasers or intensive light sources: oral presentation for American Society for Laser Medicine and Surgery Orlando/-Florida. Lasers Surg Med 1998; 23 (1) 18-24
  • 53 Adrian RM, Tanghetti EA. Long pulse 532-nm laser treatment of facial telangiectasia. Dermatol Surg 1998; 24 (1) 71-74
  • 54 Berlien HP, Waldschmidt J, Muller G. Laser treatment of cutaneous and deep vessel anomalies. In: Waidelich W, Waidelich R, , eds. Laser '87: Optoelectronics in Medicine. Berlin: Springer; 1987: 526-528
  • 55 Werner JA, Lippert BM, Hoffmann P, Rudert H. Nd:YAG laser therapy of voluminous hemangiomas and vascular malformations. Adv Otorhinolaryngol 1995; 49: 75-80
  • 56 Pfefer TJ, Smithies DJ, Milner TE, van Gemert MJC, Nelson JS, Welch AJ. Bioheat transfer analysis of cryogen spray cooling during laser treatment of port wine stains. Lasers Surg Med 2000; 26 (2) 145-157
  • 57 Zenzie HH, Altshuler GB, Smirnov MZ, Anderson RR. Evaluation of cooling methods for laser dermatology. Lasers Surg Med 2000; 26 (2) 130-144
  • 58 Fisher GH, Kim KH, Bernstein LJ, Geronemus RG. Concurrent use of a handheld forced cold air device minimizes patient discomfort during fractional photothermolysis. Dermatol Surg 2005; 31 (9 Pt 2) 1242-1243 , discussion 1244
  • 59 Raulin C, Grema H. Single-pass carbon dioxide laser skin resurfacing combined with cold-air cooling: efficacy and patient satisfaction of a prospective side-by-side study. Arch Dermatol 2004; 140 (11) 1333-1336
  • 60 Greve B, Hammes S, Raulin C. The effect of cold air cooling on 585.  nm pulsed dye laser treatment of port-wine stains. Dermatol Surg 2001; 27 (7) 633-636
  • 61 Tierney EP, Hanke CW. The effect of cold-air anesthesia during fractionated carbon-dioxide laser treatment: Prospective study and review of the literature. J Am Acad Dermatol 2012; 67 (3) 436-445
  • 62 Tierney EP, Hanke CW. Ablative fractionated CO2, laser resurfacing for the neck: prospective study and review of the literature. J Drugs Dermatol 2009; 8 (8) 723-731
  • 63 Tierney EP, Hanke CW. Treatment of poikiloderma of Civatte with ablative fractional laser resurfacing: prospective study and review of the literature. J Drugs Dermatol 2009; 8 (6) 527-534
  • 64 Tierney EP, Hanke CW, Watkins L. Treatment of lower eyelid rhytids and laxity with ablative fractionated carbon-dioxide laser resurfacing: Case series and review of the literature. J Am Acad Dermatol 2011; 64 (4) 730-740
  • 65 Sokolowski CJ, Giovannitti Jr JA, Boynes SG. Needle phobia: etiology, adverse consequences, and patient management. Dent Clin North Am 2010; 54 (4) 731-744
  • 66 Do DV, Kelley LC. Tumescent anesthesia: evolution and current uses. Adv Dermatol 2007; 23: 33-46
  • 67 Pay AD, Kenealy J. The use of nerve blocks in the laser treatment of cutaneous lesions. Br J Plast Surg 1997; 50 (2) 132-134
  • 68 Selander D. Nerve toxicity of local anaesthetics. In: Lofstriim JB, Sjiistrand U, , eds. Local Anaesthesia and Regional Block-Ade. Oxford: Elsevier Science; 1988: 77-97
  • 69 Macht SD, Thompson LW. Intraoral field block anesthesia for extraoral lesions. Surg Gynecol Obstet 1978; 146 (1) 86-89
  • 70 Eriksson E , ed. Illustrated Handbook in Local Anaesthesia. Copenhagen: Munksgaard; 1969: 60-66
  • 71 Atkinson RS, Rushman GB, Davies NJH. Lee's Synopsis of Anaesthesia.1lth ed. Oxford: Butterworth-Heinemann; 1993: 628-633
  • 72 Goodman G. Dermabrasion using tumescent anesthesia. J Dermatol Surg Oncol 1994; 20 (12) 802-807
  • 73 Field LM. Problems of tumescent anesthesia for dermabrasion. Dermatol Surg 1997; 23 (6) 497-499
  • 74 Hanke CW. The tumescent facial block: tumescent local anesthesia and nerve block anesthesia for full-face laser resurfacing. Dermatol Surg 2001; 27 (12) 1003-1005
  • 75 Namias A, Kaplan B. Tumescent anesthesia for dermatologic surgery. Cosmetic and noncosmetic procedures. Dermatol Surg 1998; 24 (7) 755-758
  • 76 Higgins TL, Hearn CJ, Maurer WG. Conscious sedation: what an internist needs to know. Cleve Clin J Med 1996; 63 (6) 355-361
  • 77 Kost M. Manual of Conscious Sedation. Philadelphia: WB Saunders; 1998
  • 78 State Medical Board of Ohio; The use of anesthesia in the office setting. Position paper. Columbus, OH: State Medical Board of Ohio; 1997
  • 79 Standard Policy for Conscious Sedation; Columbus, OH: Grant/Riverside Methodist Hospital, Ohio Health Systems; 1997
  • 80 Abeles G, Warmuth IP, Sequeira M, Swensen RD, Bisaccia E, Scarborough DA. The use of conscious sedation for outpatient dermatologic surgical procedures. Dermatol Surg 2000; 26 (2) 121-126
  • 81 Committee on Guidelines of Care. Guidelines of care for office surgical facilities. Part I. J Am Acad Dermatol 1992; 26 (5 Pt 1) 763-765
  • 82 Drake LA, Ceilley RI, Cornelison RL , et al; American Academy of Dermatology. Guidelines of Care for Office Surgical Facilities. Part II. Self-assessment checklist. J Am Acad Dermatol 1995; 33 (2 Pt 1) 265-270
  • 83 AAAHC guidelines. Skokie, IL: AAAHC; 1993
  • 84 American Academy of Pediatrics Committee on Drugs. American Academy of Pediatrics Committee on Drugs: Emergency drug doses for infants and children. Pediatrics 1988; 81 (3) 462-465
  • 85 Odom J. Tips for RN-administered conscious sedation. Todays Surg Nurse 1996; 18 (5) 22-25
  • 86 White PF. Ambulatory anesthesia advances into the new millennium. Anesth Analg 2000; 90: 1234-1235
  • 87 Larson P. Evaluation of the patient and preoperative preparation. In: Larson P. Clinical Anesthesia; 2nd ed. Philadelphia: JB Lippincott; 1992: 550
  • 88 Berry FA. Outpatient anesthesia should not be limited to ASA Class I patients. Anesthesiology 1984; 60 (6) 620
  • 89 Friedberg BL. Propofol-ketamine technique. Aesthetic Plast Surg 1993; 17 (4) 297-300
  • 90 Friedberg BL. Facial laser resurfacing with the propofol-ketamine technique: room air, spontaneous ventilation (RASV) anesthesia. Dermatol Surg 1999; 25 (7) 569-572
  • 91 Friedberg BL. Propofol-ketamine technique: dissociative anesthesia for office surgery (a 5-year review of 1264 cases). Aesthetic Plast Surg 1999; 23 (1) 70-75
  • 92 Oxorn DC, Ferris LE, Harrington E, Orser BA. The effects of midazolam on propofol-induced anesthesia: propofol dose requirements, mood profiles, and perioperative dreams. Anesth Analg 1997; 85 (3) 553-559
  • 93 Blakeley KR, Klein KW, White PF, Trott S, Rohrich RJ. A total intravenous anesthetic technique for outpatient facial laser resurfacing. Anesth Analg 1998; 87 (4) 827-829
  • 94 Fitzpatrick RE, Williams B, Goldman MP. Preoperative anesthesia and postoperative considerations in laser resurfacing. Semin Cutan Med Surg 1996; 15 (3) 170-176