How is cardiovascular disease addressed during the dermatologic preoperative evaluation and management?

Updated: Mar 16, 2020
  • Author: Robert A Schwartz, MD, MPH; Chief Editor: Dirk M Elston, MD  more...
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Answer

Inquiry into the details of a patient's cardiovascular disease is essential. Patients with histories of ischemic coronary artery disease or angina may need sublingual nitroglycerin, which should be readily available. The use of epinephrine in local anesthetics may be detrimental because of the vasoconstrictive and cardiostimulatory effects.

Patients with valvular heart disease or prosthetic valves have a greater risk of developing endocarditis. However, the occurrence of bacteremia with routine skin surgery is very low and may not necessitate prophylactic antibiotics. Nevertheless, the anticipated manipulation of abscesses or infected regions warrants prophylactic antibiotic coverage. Eroded skin lesions are most frequently colonized by Staphylococcus aureus and require prophylaxis. First-generation oral cephalosporins or oral dicloxacillin are considered useful.

Furthermore, patients with cardiac pacemakers or defibrillators should be identified during the history. Potential pacemaker interference is a consideration if using electrocautery, particularly with demand-type pacemakers. Heat coagulation devices or carbon dioxide lasers provide safe alternatives for coagulation. Simple electrodesiccation of small lesions located distant to the pacemaker poses negligible risk. However, a patient's cardiologist should be notified in advance if the defibrillator requires inactivation with magnetic fields. Bipolar cautery obviates the concern of disabling the pacemaker or initiating arrhythmia.


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