Phenol peels anesthesia

General anesthesia is not always considered to be an additional risk factor during phenol peels. 

According to the medical literature, general anesthesia (GA) should not be considered as an additional cardiovascular risk factor during a phenol peel. However, there are other effective techniques that are less complex and also less dangerous. What is more, it is in the hours following treatment that the pain is at its height - a long time after the GA has worn off. GA is a needless source of stress. 

GA does not make the patient more comfortable or any safer. On the contrary, it adds the inherit risks of general anesthesia to those of the phenol peel. GA is not the ideal choice for a full-face phenol peel. It is never indicated for a local phenol peel. 

Before a fuU-face phenol peel, the patient is always put on a drip, electrocardiographic monitoring, pulse oximeter and blood pressure monitor. The doctor has everything he needs at his disposal in case of any allergic, vagal or other reactions. Although bupivacaine, ropivacaine or mepivacaine can be employed for FNB, these products should not be used for the reasons set out above, and anesthesia should consist of FNB with lidocaine without adrenaline and with deep sedation. 

Chapter 33 is devoted to the details of anesthesia for a phenol peel. Lip Eyelid formula can be applied without any anesthetic on small areas, however. Patients feel an intense burning sensation a few seconds after application. They will have been told that the burning sensation only lasts for 15 seconds and that they can have a nerve block if they want. Vocal anesthesia plays an important part, and the patient can take a paracetamol (acetaminophen) plus codeine tablet 1 hour before the treatment. Nerve blocks are often used to increase patient comfort 2% Hdocaine without adrenaline (epinephrine) is used, and its duration of action is sufficient. The patient should be given paracetamol plus codeine tablets for the post-peel pain, which is inevitable during the first 24 hours because of the severity and rapidity of inflammation caused by the peel. 

Cardiovascular Effects. There have been several reports of cardiac arrhythmias associated with application of phenol solutions to the skin in connection with the surgical procedure of skin peeling (Gross 1984 Truppman and Ellenby 1979 Warner and Harper 1985). In this procedure, a mixture of phenol ( 50% w/v), hexachlorophene, and croton oil is applied to the skin while the patient is under anesthesia. In a series of 54 patients in which the whole face was peeled in 1 day, cardiac arrhythmias were reported in 39%, while in a series of patients in which half the face was treated on 1 day, and the second half was treated 24 hours later, cardiac arrhythmias were reported in 22% (Gross 1984). The study author also indicated that the arrhythmias were less severe in the patients treated over a longer period of time. 

Phenol is a benzyl alcohol and a major oxidized metabolite of benzene that was introduced into medicine as an antiseptic (1). Although it can be prepared in an aqueous solution or in glycerine, it appears to be more effective when mixed in aqueous compounds. At a concentration of 0.2% it is bacteriostatic and at over 1% bactericidal (2). In addition to its uses as an antiseptic and disinfectant, phenol is also used as a sclerosant, as a local anesthetic on the skin, and as an analgesic, by injection into nerves or spinally, but its use was limited by severe adverse effects. Current medical uses include cosmetic face peeling, nerve injections, and topical anesthesia. It is also an ingredient of various topical formulations, and is used as an environmental disinfectant. 

Raised telangiectasias may become more visible in patients with thin and transparent skin. Facial telangiectasias can be electrocoagulated immediately before the phenol is applied, while the patient is under nerve-block anesthesia for the peel. An Elhnan radiofrequency unit is completely satisfactory in this indication. 

A localized Litton or Baker-Gordon peel can be carried out with short-acting nerve blocks with 2% lidocaine without adrenaline (epinephrine). The pain is also short-lived. Phenol provides anesthesia that extends about 1 cm beyond the frosting, and the phenol can be applied slowly, step by step. 

Phenol is neurolytic it makes the skin less sensitive for several days, and it is possible to touch up certain areas without causing any real pain after the nerve block anesthesia has worn off, even the day after the peel. Even if deep inflammatory phenomena make the dermis painful, the epidermis remains insensitive. 

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