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Table 7 Patient management in the operating theater

From: Multicentre consensus recommendations for skin care in inherited epidermolysis bullosa

Procedure Measures to be adopted
Operating table • Place an anti-decubitus mattress and cushion on the table
• Use the sheet to lift the infant and move him/her to the operating table; older patients should move themselves
• Pad trauma-exposed sites (e.g. chin, occiput, elbows, heel, hands, feet)
Premedication • Administer oral premedication 45 minutes prior surgery in order to reduce/prevent:
Patient anxiety (midazolam 0.5 mg/kg)
Oral secretion (atropine 40 mcg/kg)
Gastro-esophageal reflux (ranitidine 1 mg/kg)
Vomiting (metoclopramide 150 mcg/kg)
• Prefer intravenous induction in presence of intravenous line, otherwise inhalational anaesthesia. In the latter case, protect the face from the mask with silicon foam (e.g. Mepilex®) or a water-based lubricant.
• Protect the eyes with a moisturizing ophthalmologic gel and the eyelids with moistened gauzes
Patient monitoring • Use tape with a silicon contact layer (Mepitac®) to fixe all tubes (e.g. endotracheal tube) and catheters
• Lubricate all tubes with a water-based lubricant
• Remove the adhesive part of electrodes allowing only the lubricated central portion to be in contact with the skin; then secure with a non adhesive dressing (e.g. Mepilex ®)
• Use clip sensors for pulse oximetry
• Use a lubricated disposable thermometer
• Pad the skin with cotton or advanced dressings under the blood pressure cuff
• Use bipolar diathermy to avoid a monopolar pad
• Avoid carefully all kinds of trauma and friction for the entire duration of surgery
Intubation • Evaluate microstomia, esophageal strictures and prominent incisors in RDEB* patients who need intubation
• Prefer fiberoptic-assisted intubation to laryngoscopy in case of difficult intubation
Recovery room • Administer a moderate sedation before emergence to avoid cutaneous lesions due to irritability
• Perform tracheal aspiration gently using soft and small tubes
  1. *RDEB, recessive dystrophic epidermolysis bullosa.