What is the dermatologic preoperative evaluation and management of anesthetic allergies?

Updated: Mar 16, 2020
  • Author: Robert A Schwartz, MD, MPH; Chief Editor: Dirk M Elston, MD  more...
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Allergies of particular concern to the cosmetic surgeon should be stressed.

Local anesthetics

True allergic reactions to local anesthetics are rare. In many cases, substituting a different class of anesthetic, such as an amide (eg, Xylocaine) for an ester (eg, Novocain), may be all that is needed because they display different antigenic determinants. More likely, sensitivity to the paraben preservatives in these agents, such as methylparaben or propylparaben, is the true culprit. Epinephrine used in some local anesthetics for hemostasis may result in a temporary tachycardia, which the patient may report erroneously as an allergy.

Topical anesthetics

EMLA cream (eutectic mixture of 5% lidocaine and 5% prilocaine) is now widely used alone or in combination with other anesthetics. Topical sensitization can result from prolonged or repeated contact. The use of an occlusive waterproof dressing (plastic wrap) reportedly enhances EMLA absorption. Application of EMLA to large body surface areas has resulted in arrhythmia and death.

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