Anesthesia and pain management for pediatric patients with dystrophic epidermolysis bullosa.
OBJECTIVE
To review anesthesia and pain management in pediatric patients with recessive dystrophic epidermolysis bullosa (RDEB).


METHODS
Retrospective study.


METHODS
University-affiliated pediatric hospital.


METHODS
25 pediatric patients with RDEB had a total of 121 surgical procedures.


RESULTS
Pediatric patients with RDEB could have vesicles and bullae formation in the skin in response to trauma, friction, or pressure. The common surgical procedures for patients with RDEB were balloon dilation of esophageal strictures (38%), pseudosyndactyly release with or without skin graft (27%), postsurgical or skin care related dressing changes (21%), percutaneous endoscopic gastrostomy tube placement (8%), and circumcision (2%). Our anesthetic techniques included general inhalational anesthesia using mask (21%), general anesthesia using endotracheal tube (48%), and intravenous sedation (31%). No death or other major perioperative anesthetic complications occurred in these reported cases.


CONCLUSIONS
Patients with RDEB can present considerable management issues for the anesthesiologists. Anesthesia and pain management can be carefully delivered with proper preoperative evaluation and preparation for pediatric patients with RDEB.
Lin
Yuan-Chi
YC
Department of Anesthesia, Children's Hospital Boston; Harvard Medical School, Boston, MA 02115, USA. yuan-chi.lin@tch.harvard.edu
Golianu
Brenda
B
D000293:Adolescent; D000768:Anesthesia, General; D002648:Child; D002675:Child, Preschool; D016292:Procedural Sedation; D016108:Epidermolysis Bullosa Dystrophica / Q000188:drug therapy / Q000601:surgery*; D005260:Female; D006801:Humans; D004091:Hydromorphone / Q000627:therapeutic use; D007223:Infant; D008297:Male; D008691:Methadone / Q000627:therapeutic use; D009020:Morphine / Q000627:therapeutic use; D010146:Pain / Q000188:drug therapy*; D019990:Perioperative Care; D011183:Postoperative Complications; D011300:Preoperative Care; D012189:Retrospective Studies
D009020:Morphine; D004091:Hydromorphone; D008691:Methadone