Tag Archives: skin care

Lidocaine Info Important For My Surgical Practice – Maximums and Toxicity

lidocaine picture from drugs.com

Lidocaine

  • Also known as Xylocaine and sometimes Lignocaine
  • Local Anesthetic
  • Antiarrhythmic drug – for ventricular arrhythmias (but Amiodarone is mostly used for this)
  • The first Amino-Amide local anesthetic
  • First marketed in 1949
  • Alters signal conduction in neurons by blocking the fast voltage gated sodium channels in the neuronal cell membrane.  Thus prevents depolarization of the postsynaptic neuron.

Esters and Amide local anesthetics – way to remember which

  • Esters have only one “i” in the name: Procaine, Cocaine
  • Amides have over two “i”s in the name:  Lidocaine, Bupivicaine, Prilocaine.

Contraindications to using Lidocaine

  • Porphyria – rare inherited or aquired disorders of enzymes which produce porphyrins and heme resulting in neurological complications (abdominal pain, vomiting, neuropathy)  or skin problems.
  • Heme is one the best known porphyrin the pigment in red blood cells and cofactor of the protein hemoglobin.
  • Porphyrin means purple

Lidocaine overdose

  • can occur with topical creams
  • Treatment with IV lipid emulsions can reverse the effects of lidocaine toxicity.

Adverse Effects

  • Rare
  • Allergic reactions rare.
  • CNS (central nervous system) and cardiovascular effects
  • CNS at lower doses, cardiac at higher doses
  • CNS: nervousness, tingling around mouth, tinnitus, tremor, dizziness, blurred vision, seizures, depression, loss of consciousness
  • Cardiovascular effects: hypotension, bradycardia, arrhythmias

Insensitivity to Lidocaine

  • Genetic
  • Exists in some patients with ADHD and Ehlers-Danlos syndrome

Lidocaine Safety and Toxic doses

  • Particular care in calculating maximum safe dose for young children
  • Peak blood levels of lidocaine usually occur 10-25 minutes after injection – the point at which toxic effects are likely to be seen.
  • Maximum safe dose of lidocaine without vasoconstrictor (ie. epinephrine) is 3-4.5 mg/kg (duration of action 1 hour).  No more than 300 mg (30 cc’s of 1% Lidocaine) at once.
  • Maximum safe dose of lidocaine with vasoconstrictor is 5-7 mg/kg (duration of action 2-6 hours)

How to calculate Maximum safe doseage of Lidocaine

  • You need to know that 1% Lidocaine solution is 10 mg/mL
  • Example Calculation for a 70 Kg man:  Lido 1% with Epi:  keep under 7 mg/Kg.  7×70 = 490 mg for 70 kg man.  Divide 490 mg by 10 mg/ML = 49 ml.

How is this important to our Plastic Surgical and Acupuncture practice?

  • We use lidocaine in plastic surgical procedures – topical and subcutaneous – for removal of moles, injection of fillers such as Juvederm, and sometimes for Botox.
  • I also use injected  lidocaine as part of some trigger point deactivation practices in acupuncture.

Cosmetic Procedures at Surgical Artistry which may use Lidocaine

  • Liposuction – tumescent lidocaine
  • Mole removal – injected subcutaneous local lidocaine
  • Fillers – Juvederm – some formulations have lidocaine within the product
  • Fillers and Botox – sometimes we use topical lidocaine
  • Face Veins – sometimes we use topical lidocaine
  • Minor office surgeries – we use injected lidocaine in the subcutaneous level

 

What do we do at Surgical Artistry?

 

5 year patients choice     surgical artistry full page ad never boring

I get this question a good deal.  I think it’s probably somewhat confusing as to what we do and we offer a lot of procedures and products.  Basically we are a two surgeon medical group offering services in Veins, Acupuncture, Plastic Surgery, and General Surgery.  That can be quite a lot.  But even with that said, it’s somewhat confusing as to what each of these items involves.  So I thought I’d make a list which doesn’t include everything, but covers most of what we do:

DR. TAMMY WU PROCEDURES:

DR. CALVIN LEE COSMETIC and BOTOX PROCEDURES:

  • Botox for cosmetic
  • Botox for headaches
  • Botox for hand and axillary sweating
  • Botox for TMJ (jaw pain)
  • Fillers (ie. Juvederm)
  • Lip Augmentation with Juvederm or other injectable fillers
  • Vein Laser
  • Vein Injections (ie. with Asclera)
  • Face Vein treatment
  • Acne Consultation
  • Skin Care Consultation
  • Cosmetic Mole Removal
  • Microdermabrasion
  • Chemical peels (ie. Obagi Blue Peel Radiance and Obagi Blue Peel)

DR. CALVIN LEE ACUPUNCTURE PROCEDURES:

  • Acupuncture trigger point deactivation for muscle pain
  • Acupuncture for back pain / neck pain
  • Acupuncture for buttock pain (ie. pyriformis syndrome)
  • Acupuncture for IT band pain (side of thighs wrapping to below knee)
  • Acupuncture for fertility
  • Acupuncture for TMJ (jaw pain)
  • Acupuncture for stress / anxiety
  • Acupuncture for allergies
  • Acupuncture for fibromyalgia
  • Acupuncture for depression
  • Acupuncture for hormones (hot flashes, acne, menstrual cycle)
  • Acupuncture for facial rejuvenation (cosmetic)
  • Acupuncture to boost the immune system
  • General wellness Acupuncture
  • Anti-nausea acupuncture for those undergoing chemotherapy or pregnancy

  SKIN CARE PRODUCTS:

  • Obagi Line
  • NIA 24 Line
  • Various Skinceuticals

 GRADUATED COMPRESSION SOCKS:

To recover faster from workouts, prevent varicose veins, and prevent injuries

  • Calf sleeves from Sigvaris and CEP brands
  • Full calf sleeves from Sigvaris and CEP brands
  • Dress socks from Sigvaris
  • Thigh high and Pantyhose compression from Sigvaris.

 Contact Us:

Surgical Artistry - Calvin Lee, MD / Tammy Wu, MD

 

Metronidazole Topical for Rosacea?

This is a note-taking blog for purposes of education – not for specific directed medical advice.

Metronidazole is a treatment available for Rosacea

  • Topical application of Metronidazole (meanning applied to the skin surface)
  • Metronidazole also comes as a pill form but this isn’t usually needed or indicated for Rosacea
  • Metronidazole is an antibiotic
  • Flagyl is the name a brand of metronidazole in pill form
  • As an antibiotic, Metronidazole is effective against anaerobic bacteria and protozoa.  It is a drug used for treating clostridium difficile infection (c. diff).
  • Topically, it comes as cream or gel
  • Metrogel is a brand (Metrogel 1%) as is Rozex.  And there are generics available for metronidazole gel or cream.
  • Many patients use metronidazole topical twice a day
  • Many patients of ours at Surgical Artistry, Modesto, report some dryness with the product and use it with a moisturizer.

Other uses of Metronidazole

  • Orally it has been used in Crohn’s disease
  • And orally, it has been used as part of the treatment for peptic ulcer disease

Obagi Rosaclear

  • a system designed by Obagi Medical for treatment of Rosacea
  • Metronidazole topical is part of the kit,
  • available as part of the rosaclear kit is a cleanser, toner, and a special tinted sunblock

What is Rosacea?

  • Some forms of it seems to be a skin infection which is related to blood vessel dilation and redness
  • Central facial redness, burning and stinging
  • visible red veins
  • bumps or blemishes
  • tight or itchy facial skin which may swell
  • Cause is unknown

What can our office in Modesto, do for Rosacea?

There are many treatments available for Roscea

  • We have Rosaclear available from Obagi
  • We have many Rosclear Sunscreen – tinted specially to hide and blend in the redness.
  • We have a vascular laser (Dornier 940, Germany) which is good for targeting the red vessels.
  • For some patients we can also prescribe clindamycin topical for rosacea

Bits of info about Retin-A (Tretinoin)

Tretinoin

Just reading for myself to review some information for myself about Retin-A (Tretinoin).  I was curious to see what info is out there and here’s some info that I gleaned from an article in the NY times, supplemented a bit with my own knowledge.  I’m always bombarded with questions and patients with different brands at our Modesto, CA office location.  Retin-A is a brand name for the chemical name:  Tretinoin or Retinoic Acid.  Derived from Vitamin A.

Other brand name Tretinoin formulations:

  • Retin-A
  • Retin-A Micro
  • Renova
  • Avage
  • Tazorac
  • Aberela
  • Airol
  • Atralin
  • Avita
  • Retacnyl
  • Refissa
  • ReTrieva
  • Stieva-A
  • Vesanoid

Retinol and Retin-A (tretinoin) are not the same thing.  Retinol is a much less potent cousin.

  • Retin-A requires a prescription, Retinol does not.

The New York times talks about “crystal-clear demonstration…”

http://www.nytimes.com/2006/11/30/fashion/30skin.html?pagewanted=all&_r=0

“To my knowledge, this is the only drug for which there has been crystal-clear demonstration that it works on the molecular level,” said Dr. John J. Voorhees, the chairman of the dermatology department at the medical school of University of Michigan”

Retin-A (Tretinoin) is used for:

  • Diminish Acne
  • improve skin texture
  • diminish wrinkles
  • fade brown spots
  • fade freckles

“There is so much historical evidence that this ingredient works better than anything else,” said Dr. Joel L. Cohen, clinical assistant professor of dermatology at the University of Colorado and a consultant for OrthoNeutrogena, the maker of Retin-A Micro. And the effects are more than superficial. “It actually works to remodel skin on a cellular level,” Dr. Cohen said.

Helping to normalize cells:

Skin cells contain retinoid receptors that help regulate how the cell functions. As people age, their cells behave more erratically. “But consistent use of Retin-A helps normalize the cells,” said Dr. Min-Wei Christine Lee, a dermatologist in Walnut Creek, Calif.

Collagen:

Retin-A does double duty in helping to boost collagen. According to research at Michigan, it has the potential to stop photoaging before it starts. “The retinoids prevent the rise of collagenase after UV exposure,” Dr. Voorhees said. Collagenase is what breaks down collagen.

But regular use of a retinoid product also increases the amount of new collagen formed, research has found, and that new collagen will last for years.

Not just cosmetic – it treats pre-cancerous lesions too

The results are not just cosmetic. Dr. Voorhees said that retinoids have been used to treat precancerous skin cells. Studies show that after two years of use, those abnormal cells returned to normal.

So if Retin-A is so effective and so well studied, why isn’t everyone using it? Many dermatologists blame a lack of patient education. “It’s one of the most misunderstood drugs,” said Dr. Kenneth Beer, a dermatologist in Palm Beach, Fla., and a clinical investigator for Allergan, the maker of prescription Avage and Tazorac. He is also an Allergan shareholder. People use Retin-A too much, use it too often, experience negative side effects and then give up on it too soon, doctors say.

The problem with Retin-A is that it may actually make skin look worse — with redness, flakiness and peeling — for up to eight weeks. “But by 24 weeks, patients will see dramatic, marked improvements,” Dr. Lee said.

We found this same thing.  Most of our patients will have dry skin, some redness, and mild peeling for about 2-3 months first before seeing the full benefits.

25 years old – but still the best:

“I can’t say there’s anything on the horizon that will rival Retin-A,” Dr. Cohen said. “It’s exciting to see all the research going into this area, but kind of funny that the thing we’re still recommending most is something that’s 25 years old.”

————-

We carry several formulations of Retinoic Acid / Tretinoin in our office:

  • Mainly Obagi 0.025%, 0.05%, and 0.1% strengths

Our Modesto Plastic Surgery office is Surgical Artistry, 2336 Sylvan Ave. Suite C, Modesto, CA 95355.  Tel 209-551-1888.