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Mittal BM, Goodnough CL, Bushell E, et al. Anesthetic Management of Adults With Epidermolysis Bullosa. Anesth Analg. 2021;doi: 10.1213/ANE.0000000000005706.
Mittal, B. M., Goodnough, C. L., Bushell, E., Turkmani-Bazzi, S., & Sheppard, K. (2021). Anesthetic Management of Adults With Epidermolysis Bullosa. Anesthesia and analgesia, . https://doi.org/10.1213/ANE.0000000000005706
Mittal, Brita M, et al. "Anesthetic Management of Adults With Epidermolysis Bullosa." Anesthesia and analgesia vol. (2021). doi: https://doi.org/10.1213/ANE.0000000000005706
Mittal BM, Goodnough CL, Bushell E, Turkmani-Bazzi S, Sheppard K. Anesthetic Management of Adults With Epidermolysis Bullosa. Anesth Analg. 2021 Aug 13; doi: 10.1213/ANE.0000000000005706. Epub 2021 Aug 13. PMID: 34403382.
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Anesth Analg. 2021 Aug 13; doi: 10.1213/ANE.0000000000005706. Epub 2021 Aug 13.

Anesthetic Management of Adults With Epidermolysis Bullosa.

Anesthesia and analgesia

Brita M Mittal, Candida L Goodnough, Erin Bushell, Sophia Turkmani-Bazzi, Kelly Sheppard

Affiliations

  1. From the Department of Anesthesiology, Perioperative, and Pain Medicine, Stanford University School of Medicine, Stanford, California.

PMID: 34403382 DOI: 10.1213/ANE.0000000000005706

Abstract

Epidermolysis bullosa (EB) is a group of rare, inherited diseases characterized by skin fragility and multiorgan system involvement that presents many anesthetic challenges. Although the literature regarding anesthetic management focuses primarily on the pediatric population, as life expectancy improves, adult patients with EB are more frequently undergoing anesthesia in nonpediatric hospital settings. Safe anesthetic management of adult patients with EB requires familiarity with the complex and heterogeneous nature of this disease, especially with regard to complications that may worsen during adulthood. General, neuraxial, and regional anesthetics have all been used safely in patients with EB. A thorough preoperative evaluation is essential. Preoperative testing should be guided by EB subtype, clinical manifestations, and extracutaneous complications. Advanced planning and multidisciplinary coordination are necessary with regard to timing and operative plan. Meticulous preparation of the operating room and education of all perioperative staff members is critical. Intraoperatively, utmost care must be taken to avoid all adhesives, shear forces, and friction to the skin and mucosa. Special precautions must be taken with patient positioning, and standard anesthesia monitors must be modified. Airway management is often difficult, and progressive airway deterioration can occur in adults with EB over time. A smooth induction, emergence, and postoperative course are necessary to minimize blister formation from excess patient movement. With careful planning, preparation, and precautions, adult patients with EB can safely undergo anesthesia.

Copyright © 2021 International Anesthesia Research Society.

Conflict of interest statement

The authors declare no conflicts of interest.

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