Anesthetic Techniques Used for Pulsed Dye Laser in the Treatment of Port-Wine Birthmarks

Pediatric Dermatology

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• In this online-survey, 49 members of the Society of Pediatric Dermatology were surveyed on anesthesia practice patterns used when treating port-wine stains with pulsed dye lasers. All providers treating port-wine stains provided laser therapy to children younger than age 4 years. In children younger than 4 years of age, 67% of respondents had parents remain in the room. Most used topical anesthesia (72%), mostly lidocaine 2.5%/prilocaine 2.5% cream, and/or general anesthesia (61%). Around a third of respondents did not use any anesthetic.

• Despite concerns for long-term effects on school performance and development caused by general anesthesia in children under 4 years of age, many pediatric dermatologists conduct pulsed dye laser treatments under general anesthesia. Further prospective studies are warranted to determine the risks of general anesthesia and clarify the guidelines.

– Margaret  Hammond, MD

Written by

 

 

Sarah L. Chamlin MD

These authors report practice patterns for treating capillary malformations with pulsed dye laser (PDL).

Most respondents were board-certified pediatric dermatologists in academic practices. A focus of this survey was use of general anesthesia (GA) for this procedure due to the concern for long-term effects on neurocognitive development. Most practitioners expressed this concern and were more likely to use GA after 1 year of age. Unfortunately, only 10.8% of the 455 respondents who opened the survey completed it, and this may be an incomplete picture of how PDL is used by pediatric dermatologists.

Due to concerns about the effects of repeated GA, many of us have shifted to "swaddle and hold" laser procedures in the first and second year of life when feasible. This is done in my practice with use of oral sucrose and an experienced nurse. This article reports use of topical anesthetics, EMLA or LMX, by 72% of respondents. I rarely use this due to the vasoconstriction noted and the theoretical decreased target vessel size when this is used.

Abstract 

BACKGROUND/OBJECTIVES

Pulsed dye laser (PDL) is the gold standard for treating port-wine birthmarks (PWBs), but no consensus exists regarding anesthetic techniques when performing PDL for PWB. Given potential adverse neurocognitive effects from general anesthesia (GA) exposure in early childhood, we sought to establish current attitudes and practice patterns regarding anesthesia when treating PWB with PDL.

METHODS

An electronic REDCap survey was distributed to members of the Pediatric Dermatology Research Alliance (PeDRA) and the Society for Pediatric Dermatology (SPD) via email. Aggregate, anonymized results were reported.

RESULTS

Among 47 respondents, the majority (83%) identified as board-certified pediatric dermatologists. When treating children <4 years old, 70% endorsed some use of topical anesthesia. Although 87% reported concerns about long-term side effects on development and school performance affecting their pursuit of GA, 61% reported use of GA for PDL in children <4 years old. All 4 (100%) respondents whose PDL was located in the operating room (OR) setting reported use of GA, compared to 6 of 17 (35%) respondents whose PDL machine was not located in the OR. Providers were more likely to use GA in patients between 1 and 4 years old (70%) compared to those <1 year old (2%).

CONCLUSIONS

Diverse practice patterns reiterate the need for a standardized anesthetic approach for PDL in young children and continued research on other factors (ie, location/accessibility of PDL, lesion size) impacting anesthesia choices. Given potential neurodevelopmental risks associated with GA, specific guidance to effectively minimize its use in favor of topical anesthetics should be provided.

Pediatric Dermatology

Anesthetic Techniques Used for Pulsed Dye Laser (PDL) in the Treatment of Port-Wine Birthmarks: An Exploratory Assessment of Current Attitudes and Practice Patterns Among Pediatric Dermatologists in the United States

Pediatr Dermatol 2021 Feb 21;[EPub Ahead of Print], A Klein, P Aggarwal, D Mannschreck, BA Cohen 

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Benjamin Hidalgo-Matlock
Skin Care Physicians of Costa Rica

Clinica Victoria en San Pedro: 4000-1054
Momentum Escazu: 2101-9574

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