Safety in Dermatologic Procedures: Hypertensive Crises and Potentially Fatal Arrhythmias.

Safety in Dermatologic Procedures: Hypertensive Crises and Potentially Fatal Arrhythmias. Actas Dermosifiliogr. 2021 Jan 27;: Authors: Rodríguez-Jiménez P, Sampedro-Ruiz R, Imaz I, Chicharro P Abstract 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...
Source: Actas Dermo-Sifiliograficas - Category: Dermatology Authors: Tags: Actas Dermosifiliogr Source Type: research