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 |