Anesthetic and Analgesic Management of Pediatric Patients for Staged Repeat Same‐Day Surgery

Martha O. Herbst; Katherine G. C. Keech; Bryan S. Brindeiro; Kristen G. Berrebi; Jennifer G. Powers; Michelle N. Bremer Gama; Stephen R. Hays

doi:10.1155/cria/7047720

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Anesthetic and Analgesic Management of Pediatric Patients for Staged Repeat Same‐Day Surgery

Journal article

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Anesthetic and Analgesic Management of Pediatric Patients for Staged Repeat Same‐Day Surgery

Martha O. Herbst, Katherine G. C. Keech, Bryan S. Brindeiro, Kristen G. Berrebi, Jennifer G. Powers, Michelle N. Bremer Gama and Stephen R. Hays

Case reports in anesthesiology, Vol.2026(1), 7047720

04/06/2026

DOI: 10.1155/cria/7047720

PMCID: PMC13051843

PMID: 41947823

Appears in UI Libraries Support Open Access

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Abstract

Background: Dermatofibrosarcoma protuberans (DFSP) is a rare dermatologic malignancy in children requiring a multidisciplinary approach for surgical excision and postoperative care. The modified "slow Mohs" repeat staged excision and the associated anesthetic technique are not well described in the pediatric literature. Case presentation: We describe three pediatric patients whose staged excision procedures were completed using general anesthesia plus systemic multimodal analgesia (all patients), including tunneled epidural catheters (two patients with truncal tumors) or a scheduled long-acting opioid (one patient with a forehead lesion). Complete dermatologic excision and excellent surgical analgesia were achieved in all patients. Specific interventions to verify epidural catheter position and allow potential prolonged catheter use were of particular utility in perioperative management. Conclusions: Children with DFSP present a unique challenge to provide optimal surgical and cosmetic results with serial staged Mohs excision while ensuring adequate ongoing analgesia. Close interdisciplinary communication and advance planning are essential. Multimodal analgesia, including tunneled epidural catheters if anatomically appropriate, or scheduled long-acting opioid, is a key component of successful management. Confirmation of epidural catheter position likely improves analgesic efficacy and reduces the need for catheter replacement. We suggest that the care of pediatric patients undergoing slow Mohs staged repeat excision is best undertaken in a tertiary care setting with adequate multidisciplinary subspecialist support.

Case Report

Mohs micrographic surgery

dermatofibrosarcoma protuberans (DFSP)

epidurography

pediatric analgesia

pediatric anesthesia

pediatric epidural

tunneled epidural catheter

UIOWA OA Agreement

Details

Title: Subtitle: Anesthetic and Analgesic Management of Pediatric Patients for Staged Repeat Same‐Day Surgery
Creators: Martha O. Herbst - University of Iowa
Katherine G. C. Keech - University of Iowa
Bryan S. Brindeiro - University of Iowa
Kristen G. Berrebi - University of Iowa
Jennifer G. Powers - University of Iowa
Michelle N. Bremer Gama - University of Iowa
Stephen R. Hays - University of Iowa
Resource Type: Journal article
Publication Details: Case reports in anesthesiology, Vol.2026(1), 7047720
DOI: 10.1155/cria/7047720
PMID: 41947823
PMCID: PMC13051843
NLM abbreviation: Case Rep Anesthesiol
ISSN: 2090-6382
eISSN: 2090-6390
Publisher: Wiley
Language: English
Date published: 04/06/2026
Academic Unit: Dermatology; Stead Family Department of Pediatrics; Anesthesia
Record Identifier: 9985152123002771

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