Videos of Surgical Procedures in Dermatology
Application of Topical Sevoflurane Before Cleaning Painful Skin Ulcers
Sevoflurano tópico previo a la limpieza de úlceras cutáneas dolorosas
A. Imbernón-Moyaa,
, J. Ortiz-de Frutosb, M. Sanjuan-Alvarezc, I. Portero-Sanchezd
Autor para correspondencia
a Servicio de Dermatología, Hospital Universitario Severo Ochoa, Leganés, Madrid, España
b Servicio de Dermatología, Hospital Doce de Octubre, Madrid, España
c Servicio de Anestesiología, Hospital Universitario Severo Ochoa, Leganés, Madrid, España
d Departamento Medicina Clínica, Universidad Complutense, Madrid, España
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Chronic pain can seriously affect quality of life, overall patient satisfaction, and professional-patient relationships.<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">1</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">Sevoflurane 100% is a halogenated ether anesthetic derivative. It is supplied as a fluid and is generally administered by inhalation. It is indicated for the induction and maintenance of general anesthesia during hospital or ambulatory surgical procedures in adults and children.<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">2</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">Topical sevoflurane has been proposed as an alternative for treating pain associated with chronic vascular ulcers.<a class="elsevierStyleCrossRefs" href="#bib0040"><span class="elsevierStyleSup">3–5</span></a> Its topical use is off-label and therefore requires informed consent for compassionate use and approval by a pharmacy commission.</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Description of Technique</span><p id="par0020" class="elsevierStylePara elsevierViewall">When cleaning an ulcer with sevoflurane, place the patient on a stretcher in a well-lit, well-ventilated area or near a window. Wear a mask at all times to prevent adverse effects from vapors.</p><p id="par0025" class="elsevierStylePara elsevierViewall">Sevoflurane (Sevorane, Abbott Laboratories, S.A.) is supplied in a 250-mL amber polyethylene naphtholate bottle and should be stored at an ambient temperature of 15°<span class="elsevierStyleSmallCaps">C</span> to 30°<span class="elsevierStyleSmallCaps">C</span> and protected from sunlight. Remove the yellow cap and, using an 18-gauge drawing needle, press down firmly into the center of the bottle until the needle is completely inserted. Connect a 3-way stopcock key to the needle and draw up the liquid through a syringe.</p><p id="par0030" class="elsevierStylePara elsevierViewall">Remove the patient's bandage and gently wash the bed of the wound with 0.9% saline. The usual dose of liquid sevoflurane is 1<span class="elsevierStyleHsp" style=""></span>mL per cm<span class="elsevierStyleSup">2</span> of wound. Protect the perilesional skin by applying petroleum jelly to the edges of the wound and covering it with a sterile dressing.</p><p id="par0035" class="elsevierStylePara elsevierViewall">Attach a 25-gauge subcutaneous needle to the syringe and administer the anesthetic by direct instillation. Cover the bed of the ulcer with a sterile dressing soaked in saline. Once the analgesic effect has set in (sevoflurane generally has a latency time of 2 to 7<span class="elsevierStyleHsp" style=""></span>minutes), proceed to clean the ulcer.</p><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Indications</span><p id="par0040" class="elsevierStylePara elsevierViewall">The analgesic use of topical sevoflurane is indicated for hospitalized or ambulatory patients with painful cutaneous lesions that are refractory to treatment with conventional painkillers.</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Contraindications</span><p id="par0045" class="elsevierStylePara elsevierViewall">Do not use topical sevoflurane in patients with a history of malignant hyperthermia or allergy or hypersensitivity to sevoflurane.</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Complications</span><p id="par0050" class="elsevierStylePara elsevierViewall">Local adverse effects associated with topical sevoflurane tend to be short-lived and mild. The most common effects are pruritus and erythema at the edges of the wound. Other effects include a sensation of irritation, stinging, heat and/or burning in the area of the ulcer and surrounding healthy skin.</p><p id="par0055" class="elsevierStylePara elsevierViewall">Local effects can occur during application and/or minutes or hours afterwards. However, they generally appear in the first 5 to 10<span class="elsevierStyleHsp" style=""></span>minutes and often dissipate in subsequent hours.</p><p id="par0060" class="elsevierStylePara elsevierViewall">Contact irritant dermatitis is rare and no cases of sensitization to topical sevoflurane have been reported.</p><p id="par0065" class="elsevierStylePara elsevierViewall">Adverse effects in perilesional skin do not generally require treatment, as they tend to resolve spontaneously. Treatment with emollients may, however, be required and on rare occasions a patient may need medium-potency topical corticosteroids.</p><p id="par0070" class="elsevierStylePara elsevierViewall">There have been no reports of adverse systemic effects, hemodynamic repercussion, dose-dependent toxicity, or cutaneous reactions at a distance from the application site.</p><p id="par0075" class="elsevierStylePara elsevierViewall">Environmental exposure risks include general malaise, dizziness, nausea, and self-limiting mild to moderate headache. Medical personnel are at risk of secondary contamination from vapors resulting from incorrect usage, and the level of exposure is greater the nearer the application site is to the person's airways. We therefore advise health care professionals to follow the indications in this document when using topical sevoflurane. Although the method will not completely eliminate risk, it will minimize the occurrence of adverse clinical effects.</p></span></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Conclusions</span><p id="par0080" class="elsevierStylePara elsevierViewall">Topical sevoflurane is a simple, noninvasive, useful, effective, and safe alternative for alleviating pain during the cleaning of painful skin ulcers. It can reduce or eliminate the need for other conventional painkillers, such as paracetamol, nonsteroidal anti-inflammatory drugs, metamizole, and opioids. It achieves a rapid, intense, and lasting analgesic effect. Topical sevoflurane has also been reported to have antibacterial and healing properties.<a class="elsevierStyleCrossRefs" href="#bib0040"><span class="elsevierStyleSup">3–5</span></a></p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Conflicts of Interest</span><p id="par0085" class="elsevierStylePara elsevierViewall">The authors declare that they have no conflicts of interest.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:6 [ 0 => array:2 [ "identificador" => "sec0005" "titulo" => "Introduction" ] 1 => array:3 [ "identificador" => "sec0010" "titulo" => "Description of Technique" "secciones" => array:3 [ 0 => array:2 [ "identificador" => "sec0015" "titulo" => "Indications" ] 1 => array:2 [ "identificador" => "sec0020" "titulo" => "Contraindications" ] 2 => array:2 [ "identificador" => "sec0025" "titulo" => "Complications" ] ] ] 2 => array:2 [ "identificador" => "sec0030" "titulo" => "Conclusions" ] 3 => array:2 [ "identificador" => "sec0035" "titulo" => "Conflicts of Interest" ] 4 => array:2 [ "identificador" => "xack349280" "titulo" => "Acknowledgments" ] 5 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Imbernón-Moya A, Frutos JO-d, Sanjuan-Alvarez M, Portero-Sanchez I. Sevoflurano tópico previo a la limpieza de úlceras cutáneas dolorosas. 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Rodríguez-Carmona" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Am J Health Syst Pharm" "fecha" => "2017" "volumen" => "74" "paginaInicial" => "176" "paginaFinal" => "182" ] ] ] ] ] ] ] ] ] ] "agradecimientos" => array:1 [ 0 => array:4 [ "identificador" => "xack349280" "titulo" => "Acknowledgments" "texto" => "<p id="par0090" class="elsevierStylePara elsevierViewall">We thank Javier Kaneshiro for his help with editing the video.</p>" "vista" => "all" ] ] ] "idiomaDefecto" => "en" "url" => "/15782190/0000010900000005/v1_201806040407/S1578219018301288/v1_201806040407/en/main.assets" "Apartado" => array:4 [ "identificador" => "6209" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Videos of Surgical Procedures in Dermatology" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/15782190/0000010900000005/v1_201806040407/S1578219018301288/v1_201806040407/en/main.pdf?idApp=UINPBA000044&text.app=https://actasdermo.org/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1578219018301288?idApp=UINPBA000044" ]
| año/Mes | Html | Total | |
|---|---|---|---|
| 2024 Noviembre | 10 | 13 | 23 |
| 2024 Octubre | 107 | 49 | 156 |
| 2024 Septiembre | 115 | 29 | 144 |
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| 2024 Marzo | 99 | 34 | 133 |
| 2024 Febrero | 90 | 37 | 127 |
| 2024 Enero | 74 | 35 | 109 |
| 2023 Diciembre | 79 | 20 | 99 |
| 2023 Noviembre | 80 | 27 | 107 |
| 2023 Octubre | 86 | 28 | 114 |
| 2023 Septiembre | 69 | 40 | 109 |
| 2023 Agosto | 56 | 16 | 72 |
| 2023 Julio | 67 | 37 | 104 |
| 2023 Junio | 85 | 24 | 109 |
| 2023 Mayo | 78 | 21 | 99 |
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| 2023 Marzo | 98 | 35 | 133 |
| 2023 Febrero | 73 | 25 | 98 |
| 2023 Enero | 64 | 38 | 102 |
| 2022 Diciembre | 90 | 49 | 139 |
| 2022 Noviembre | 47 | 30 | 77 |
| 2022 Octubre | 46 | 22 | 68 |
| 2022 Septiembre | 49 | 35 | 84 |
| 2022 Agosto | 69 | 37 | 106 |
| 2022 Julio | 53 | 37 | 90 |
| 2022 Junio | 32 | 22 | 54 |
| 2022 Mayo | 76 | 51 | 127 |
| 2022 Abril | 88 | 35 | 123 |
| 2022 Marzo | 83 | 57 | 140 |
| 2022 Febrero | 61 | 37 | 98 |
| 2022 Enero | 55 | 51 | 106 |
| 2021 Diciembre | 49 | 42 | 91 |
| 2021 Noviembre | 63 | 61 | 124 |
| 2021 Octubre | 56 | 64 | 120 |
| 2021 Septiembre | 49 | 38 | 87 |
| 2021 Agosto | 36 | 39 | 75 |
| 2021 Julio | 40 | 27 | 67 |
| 2021 Junio | 47 | 32 | 79 |
| 2021 Mayo | 41 | 45 | 86 |
| 2021 Abril | 64 | 53 | 117 |
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| 2021 Enero | 40 | 16 | 56 |
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| 2020 Noviembre | 44 | 25 | 69 |
| 2020 Octubre | 28 | 17 | 45 |
| 2020 Septiembre | 50 | 18 | 68 |
| 2020 Agosto | 50 | 13 | 63 |
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| 2020 Junio | 55 | 27 | 82 |
| 2020 Mayo | 19 | 7 | 26 |
| 2020 Abril | 28 | 17 | 45 |
| 2020 Marzo | 37 | 24 | 61 |
| 2020 Febrero | 6 | 0 | 6 |
| 2020 Enero | 4 | 0 | 4 |
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| 2019 Noviembre | 2 | 0 | 2 |
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| 2019 Mayo | 6 | 0 | 6 |
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| 2019 Marzo | 2 | 0 | 2 |
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