Anesthetic Management of Emergency Cesarean Section in a Patient with Epidermolysis Bullosa Dystrophica Polydysplastica

A review of the obstetric management of patients with epidermolysis bullosa

“…There were no associated skin complications reported as a result of this induction method. 4 By contrast, a general anaesthetic was deemed to be too dangerous for the patient we recently managed ('pregnancy 9' of Table 1) despite the site of induction of regional anaesthesia being infected with MRSA, which posed a significant risk of bacterial meningitis. These two pregnancies highlight the need for a risk versus benefit approach when it comes to the decision of anaesthesia for caesarean section.…”

“…The first reported pregnancy in the literature occurred in 1978. 4 Since this time there have been only seven further pregnancies 4 -8 that have been reported in the literature as shown in Table 1. We have included a ninth pregnancy recently managed at St Thomas' Hospital, London.…”

“…A general anaesthesia was given because spinal and epidural anaesthesia were contraindicated due to infected ulcers in the lumbosacral area. 4 A face mask saturated in lubricant gel and hydrocortisone ointment allowed general anaesthesia induction. There were no associated skin complications reported as a result of this induction method.…”

“…It is very important that on inspection to determine the puncture site, one meticulously looks for any evidence of infection as this may be a contraindication for regional anaesthesia. 4 As patients with EB are frequently malnourished, determination of the bony landmarks is often incredibly simple. 16 The skin must be well cleansed with antiseptic spray and any frictional forces of wiping should be avoided.…”

Anaesthesia for correction of oesophageal stricture in a patient with recessive epidermolysis bullosa dystrophica: Case report

“…It is suggested the disease may effect primarily only squamous epithelium (mucosa of the tongue, lip, oropharynx, epiglottis) resulting in involvement of the upper but not the lower airway, since the laryngeal and tracheal lining is primarily pseudostratified columnar epithelium. 7 Associated malnutrition, skeletal demineralization, and electrolyte abnormalities may present problems and total parenteral nutrition s may be necessary postoperatively. Alteration in protein binding of drugs is a consideration.…”