Undesirable effects of permanent makeup: complications after anesthesia

Anesthesia during permanent makeup is done in order to provide the client with maximum comfort and to secure the permanent makeup procedure. After all, being under the influence of anesthesia, the client's nerves will not react to irritation and not a single muscle of the face will twitch accidentally. This can guarantee the application of clear lines.

However, this does not reduce the risk from using the anesthetics themselves. So, what can a permanent makeup master face when using anesthesia?

Local reactions : pallor, hyperemia and swelling at the site of application of the drug, slight burning and itching immediately after application of the drug, hemorrhagic rash or pinpoint hemorrhages.
Systemic reactions : very rarely (<0.1%) allergic reactions (in severe cases - anaphylactic shock).
Local reactions to the drug can occur quite often (> 1%) and are reversible, but an allergic reaction in the form of anaphylactic shock, although extremely rare (especially with topical anesthesia), ends in 10-20% of cases fatally.
We will not consider the treatment of anaphylactic shock in full, since only physicians are involved in the treatment, but the symptoms of this phenomenon and the procedure in such a situation must be known to the PM master without fail.

Anaphylaxis

Anaphylactic shock or anaphylaxis is a state of sharply increased sensitivity of the body that develops only with repeated administration of medications.

The rate of occurrence of anaphylactic shock is from a few seconds or minutes to 2 hours from the start of contact with the allergen. In the development of an anaphylactic reaction in patients with a high degree of sensitization, neither the dose nor the method of allergen administration play a decisive role. However, a large dose of the drug increases the severity and duration of the shock.

Symptoms of anaphylactic shock

The first symptom or even a harbinger of the development of anaphylactic shock is a pronounced local reaction at the site of the allergen entering the body - unusually severe pain, severe swelling, swelling and redness at the injection or application site, severe itching of the skin, quickly spreading throughout the skin.

Expressed edema of the larynx, bronchospasm and laryngospasm quickly join, leading to a sharp difficulty in breathing. Difficulty breathing leads to the development of rapid, noisy, hoarse breathing. Hypoxia develops. The patient becomes very pale, the lips and visible mucous membranes, as well as the distal ends of the limbs (fingers) may become cyanotic. In a patient with anaphylactic shock, blood pressure drops sharply and collapse develops. The patient may lose consciousness or faint. Anaphylactic shock develops very quickly and can lead to death within minutes or hours after the allergen enters the body.

According to the severity of the course , 4 degrees of anaphylactic shock are distinguished:

Grade 1 (mild): the duration of development is from several minutes to 2 hours, characterized by itching of the skin, hyperemia of the skin and rash, the appearance of headache, dizziness, a feeling of flushing to the head, sneezing, itching, rhinorrhea, hypotension, tachycardia, a feeling of heat, increasing weakness, discomfort in various areas of the body;

Grade 2 (moderate): the average severity of anaphylactic shock is characterized by the most detailed clinical picture: toxidermia, Quincke's edema, conjunctivitis, stomatitis, circulatory disorders - increased heart rate, pain in the heart, arrhythmia, lowering blood pressure, severe weakness, dizziness, visual impairment, restlessness, agitation, a feeling of fear of death, trembling, pallor, cold sticky sweat, hearing loss, ringing and noise in the head, fainting. Against this background, it is possible to develop an obstructive syndrome similar to an attack of bronchial asthma with the manifestation of cyanosis, the presence of gastrointestinal (nausea and vomiting, bloating, swelling of the tongue, pain in the lower abdomen, diarrhea with blood in the feces, severe pain in the abdomen) and renal ( urge to urinate, polyuria) syndromes.

Grade 3 (severe): manifested by loss of consciousness, acute respiratory and cardiovascular failure (shortness of breath, cyanosis, stridor breathing, small rapid pulse, a sharp decrease in blood pressure, high Algover index);

Grade 4 (extremely severe): collapse develops at lightning speed (pallor, cyanosis, thready pulse, a sharp decrease in blood pressure), coma (with loss of consciousness, involuntary defecation and urination), pupils are dilated, their reaction to light is absent. With a subsequent drop in blood pressure, the pulse and blood pressure are not determined, the heart stops, breathing stops.

Possible options for anaphylactic shock with a primary lesion:

• skin with increasing skin itching, hyperemia, the appearance of common urticaria, Quincke's edema;
• nervous system (cerebral variant) with the development of severe headache, nausea, hyperesthesia, paresthesia, convulsions with involuntary urination and defecation, loss of consciousness with clinical manifestations of the type of epilepsy;
• respiratory organs (asthmatic variant) with dominant suffocation and the development of asphyxia due to changes in the patency of the upper respiratory tract due to laryngeal edema and impaired patency of the medium and small bronchi;
• heart (cardiogenic) with the development of a picture of acute myocarditis or myocardial infarction and other organs.

However, there is a pattern: the less time has passed from the moment the allergen enters the body, the more severe the clinical picture of shock. Anaphylactic shock gives the highest percentage of deaths when it develops after 3-10 minutes. after exposure to the allergen.

First aid for anaphylactic shock

First of all, before the procedure, the master should definitely find out from the client if he has a history of non-specific reactions to any types of anesthetics. If in the past the client had any suspicious condition when using anesthesia, even if it was not complicated (headache, increased pressure, dizziness, redness, itching, etc.), this may be a sign of an allergic reaction. In this case, it is better to abandon the use of anesthesia altogether.

In cases of application of local anesthetics by application, the dose of the drug that penetrates into the blood is usually very small, and can be equated to the dose used by physicians for an allergy test. Therefore, when using an anesthetic by application, it is more likely to develop anaphylactic shock of the 1st degree of severity with a predominant lesion of the skin. If, however, the client’s condition is not responded to at an early stage, the degree and course of the anaphylactic reaction may worsen (although a small dose and method of administration of the drug may not necessarily affect the severity of the reaction if the client has a state of sharply increased sensitivity of the body to the allergen).

If a client is showing signs of grade 1 anaphylaxis, they should:

• immediately remove the remaining anesthetic from the surface of the skin;
• rinse the site of application of the anesthetic well with running water;
• put the client in a horizontal position;
• open an ampoule of dexamethasone or prednisolone and lubricate the site of anesthetic application with a moistened cotton pad for several minutes;
• give the client an antihistamine tablet to drink (for example, diphenhydramine, suprastin, tavegil, claritin, etc.);
• provide access to fresh air;
• give hot tea to drink;
• lubricate the site of application of the anesthetic with hydrocortisone ointment;
• after stabilization of the condition, send the client home, reschedule the procedure for another day (without the use of anesthetic).

If the client has signs of anaphylaxis 2,3,4 severity, you should:

• immediately call an ambulance;
• perform the same actions as in cases of 1 degree of severity;
• observe that inhalation of vomit does not occur - keep your head to one side and fix your tongue if it sinks;
• be sure to have a first aid kit with an extended set of medicines;
• perhaps before the arrival of the ambulance team, the doctor on duty may instruct you to take any action (resuscitation measures can only be carried out by medical staff).

Be vigilant and attentive to your customers. Never panic and soberly assess the situation. Remember, your knowledge is a weapon in any situation.