Practical Plastic Surgery by Kryger Z.B., Sisco M.

By Kryger Z.B., Sisco M.

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By Kryger Z.B., Sisco M.

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If poor hemostasis is presumed or if the wound is particularly “weepy”, close monitoring of the patient’s hemodynamic and fluid status is warranted. • The foam should not encroach on normal surrounding skin. However, two separate wounds can be hooked up to a single suction tubing by bridging the two sponges with a thin piece of foam that traverses the normal interfering skin. • A useful trick for dressing change analgesia is to clamp the tubing and inject 1% lidocaine with epinephrine (10-30 ml) into the tubing distal to the clamp.

Its CNS effects are stimulatory before leading to confusion, dysphoria and seizures. The maximum safe dose is about 3 mg/kg. Tetracaine Tetracaine, similar to cocaine, is used as a topical agent in nasal surgery. It can also be combined with EMLA as a topical agent for anesthesia for closed nasal reduction. 05% to 4% solution. It has a rapid onset and is effective for 1-3 hours. Tetracaine is several times more potent than cocaine. It is extremely toxic due to its slow rate of metabolism, and the maximum safe dose is 1 mg/kg.

Within 2 hours, the maximal depth of penetration is reached. EMLA cream is not widely used because of the long latency until onset of action and the need for the occlusive dressing. It is effective in children who will not tolerate a needle stick, as long as it is applied sufficiently in advance. Cocaine Cocaine is used primarily as a topical agent for septo-rhinoplasty procedures. It comes in 4% or 10% solutions. As opposed to other local anesthetics, cocaine produces significant local vasoconstriction without the addition of epinephrine.

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