Perioperative Care, Anesthesia, and Complications
Anesthesia
Know local anesthetic pharmacology: lidocaine with epinephrine, maximum dosing, and the role of epinephrine for hemostasis and prolonged anesthesia. Understand buffering to reduce injection pain and the recognition of epinephrine sensitivity. Know when to avoid epinephrine (digits, though evidence supports cautious use) and how to manage anesthetic toxicity.
Perioperative care
Understand anticoagulation management - most patients can continue antiplatelets and anticoagulants with careful hemostasis. Know antibiotic prophylaxis indications (prosthetic joints, valvular disease per current guidance). Recognize complications: bleeding, infection, dehiscence, hypertrophic scar, nerve injury, and vasovagal events.
Traps
A common trap is stopping anticoagulation unnecessarily, increasing thromboembolic risk. Another is overusing antibiotics for clean Mohs wounds. Know that epinephrine-containing solutions can cause tachycardia and tremor, which may be mistaken for anxiety.
Rule of thumb
Calculate maximum lidocaine dose by weight and account for epinephrine's effect on duration. Example: a 70 kg patient tolerates roughly 7 mg/kg plain lidocaine or up to 7 mg/kg with epinephrine (institutional limits vary); track cumulative dose across stages in a long case.