LAUSR

As dermatologic surgeons often have to perform long surgeries with local anesthetic only, they should be familiar with the fundamentals of how to manage 2 potentially serious complications: hypertensive crises and intraoperative arrhythmias. Hypertensive crises can be classified as 1) hypertensive urgencies, characterized by a significant spike in blood pressure (BP) (>180/110 mm Hg) without target-organ dysfunction or 2) hypertensive emergencies, characterized by a BP above 180/110 mm Hg with progressive target-organ damage. In emergencies, the BP needs to be reduced immediately whereas in urgencies the goal is to reduce the BP over several days. Care must still be taken not to reduce the BP excessively rapidly in emergencies, however, to avoid ischemic injury to vascular beds that have adapted to a high BP. We recommend that dermatologic surgeons use captopril in hypertensive emergencies because of its safety profile and ease of use. Asymptomatic intraoperative bradycardia does not require treatment, but patients should always be checked to ensure they are alert and responsive. The first step in clinically stable patients with tachycardia is to measure the width of the QRS complex and notify the anesthetist when this is wide. Dermatologic surgeons should also be familiar with the drugs available in the operating room, ensure that they are easily accessible, and identify the most essential ones so they can familiarize themselves with indications and dosage. Patients should be monitored throughout the operation, and material to secure a peripheral intravenous line should be prepared in case of need. Finally, the dermatologic surgeon should know all the staff working in the operating room and be able to locate the specialist in anesthesia and resuscitation.