Case Report
Volume 4 Issue 1 - 2020
Pitfalls during Anesthetic Management of Dystrophic Epidermolysis Bullosa; A Case Study
Mahamed Salah Eldeen Alkateb*, Walid Hasan Ibrahim Moftah*, Raiya Saif ALBahri and Arpan Kumar Sashankar
Anesthesia and intensive care department, Royal Hospital, Muscat, Oman
*Corresponding Author: Mahamed Salah Eldeen Alkateb and Walid Hasan Ibrahim Moftah, Anesthesia and Intensive Care Department, Royal Hospital, Muscat, Oman.
Received: November 21, 2019; Published: December 05, 2019




Abstract

Introduction: Epidermolysis bullosa is a group of genetic diseases that leads to a defect in the dermo-epidermal junction. It affects the skin and mucosa leading to blistering and bullae formation on handling. Similar problems can occur in the mouth and pharynx and this can result in poor mouth opening or tracheal stenosis [1].

Case Report: This case study describes the management and anesthetic plan of a dystrophic epidermolysis bullosa (DEB) case who reached the age of 30 years.

This patient presented with dysphagia to solid food and was posted for dilatation of esophageal stricture under General Anesthesia GA. The patient had a history of difficult intubation, Airway assessment revealed Mallampati class 4, missing teeth, and poor oral hygiene with a thyromental distance of less than 3 cm and restricted mouth opening. The procedure was done with awake intubation followed by GA. Gastroenterologist failed to find an esophageal opening after many trials he abandoned the procedure and advised to do Gastrostostomy.

The patient was shifted intubated to ICU. After 72 hours he was sent back to Operating theatre for extubation with backup surgery team for tracheostomy if needed.

Extubation was uneventful, the patient’s family decided to get a second opinion regarding the gastrostomy.

Conclusion: Introducing the best care to DEB patients necessitate Proper planing for each step, and multidisciplinary teamwork, even in simple procedures. Through this study, we will highlight the pitfalls that should be considered in such cases in the future.

 

Keywords: Dystrophic Epidermolysis Bullosa; Anesthetic Management; Pitfalls

References

    1. Mills GH. “Pulmonary disease and anesthesia”. Oxford textbook of anesthesia volume 1, first edition (82) (2017): 1405-1432.
    2. Dierdorf SF. “Anesthesia For Patients With Rare And Coexisting Diseases”. Clinical Anesthesia Book 5th edition (19) (2006): 525-527.
    3. Marschall KE. “Skin and Musculoskeletal Diseases”. Stoelting’s Anesthesia and coexisting disease 7th edition (25) (2018): 507-537.
    4. Saraf SV., et al. “Epidermolysis bullosa: Careful monitoring and no-touch principle for anesthesia management”. Journal of Anaesthesiology Clinical Pharmacology 3 (2013): 390-393.
    5. Anesthesia recommendations for patients suffering from epidermolysis bullosa. Orphan anesthesia (2012).
    6. Iohom G and Lyons B. “Anaesthesia for children with epidermolysis bullosa: a review of 20 years' experience”. European Journal of Anaesthesiology 11 (2001): 745-754.
    7. Crowley KL and Shevchenko YO. “Anesthetic management of a difficult airway in a patient with epidermolysis bullosa: A case report”. AANA Journal 72 (2004): 261-263.
    8. Furukawa LK. Guidelines for the Anesthetic Management of Epidermolysis Bullosa (EB) produced by the division of pediatric anesthesia and pain management Lucile Salter Pakard Children’s Hospital (650) 723-5728.
    9. Siddiqui KM and Khan S. “Anaesthetic management of an infant with epidermolysis bullosa undergoing inguinal hernia repair”. Journal of Pakistan Medical Association 6 (2010): 497-498.
Citation: Mahamed Salah Eldeen Alkateb, Walid Hasan Ibrahim Moftah., et al. “Pitfalls during Anesthetic Management of Dystrophic Epidermolysis Bullosa; A Case Study”. EC Emergency Medicine and Critical Care 4.1 (2020): 01-07.

PubMed Indexed Article


EC Pharmacology and Toxicology
LC-UV-MS and MS/MS Characterize Glutathione Reactivity with Different Isomers (2,2' and 2,4' vs. 4,4') of Methylene Diphenyl-Diisocyanate.

PMID: 31143884 [PubMed]

PMCID: PMC6536005


EC Pharmacology and Toxicology
Alzheimer's Pathogenesis, Metal-Mediated Redox Stress, and Potential Nanotheranostics.

PMID: 31565701 [PubMed]

PMCID: PMC6764777


EC Neurology
Differences in Rate of Cognitive Decline and Caregiver Burden between Alzheimer's Disease and Vascular Dementia: a Retrospective Study.

PMID: 27747317 [PubMed]

PMCID: PMC5065347


EC Pharmacology and Toxicology
Will Blockchain Technology Transform Healthcare and Biomedical Sciences?

PMID: 31460519 [PubMed]

PMCID: PMC6711478


EC Pharmacology and Toxicology
Is it a Prime Time for AI-powered Virtual Drug Screening?

PMID: 30215059 [PubMed]

PMCID: PMC6133253


EC Psychology and Psychiatry
Analysis of Evidence for the Combination of Pro-dopamine Regulator (KB220PAM) and Naltrexone to Prevent Opioid Use Disorder Relapse.

PMID: 30417173 [PubMed]

PMCID: PMC6226033


EC Anaesthesia
Arrest Under Anesthesia - What was the Culprit? A Case Report.

PMID: 30264037 [PubMed]

PMCID: PMC6155992


EC Orthopaedics
Distraction Implantation. A New Technique in Total Joint Arthroplasty and Direct Skeletal Attachment.

PMID: 30198026 [PubMed]

PMCID: PMC6124505


EC Pulmonology and Respiratory Medicine
Prevalence and factors associated with self-reported chronic obstructive pulmonary disease among adults aged 40-79: the National Health and Nutrition Examination Survey (NHANES) 2007-2012.

PMID: 30294723 [PubMed]

PMCID: PMC6169793


EC Dental Science
Important Dental Fiber-Reinforced Composite Molding Compound Breakthroughs

PMID: 29285526 [PubMed]

PMCID: PMC5743211


EC Microbiology
Prevalence of Intestinal Parasites Among HIV Infected and HIV Uninfected Patients Treated at the 1o De Maio Health Centre in Maputo, Mozambique

PMID: 29911204 [PubMed]

PMCID: PMC5999047


EC Microbiology
Macrophages and the Viral Dissemination Super Highway

PMID: 26949751 [PubMed]

PMCID: PMC4774560


EC Microbiology
The Microbiome, Antibiotics, and Health of the Pediatric Population.

PMID: 27390782 [PubMed]

PMCID: PMC4933318


EC Microbiology
Reactive Oxygen Species in HIV Infection

PMID: 28580453 [PubMed]

PMCID: PMC5450819


EC Microbiology
A Review of the CD4 T Cell Contribution to Lung Infection, Inflammation and Repair with a Focus on Wheeze and Asthma in the Pediatric Population

PMID: 26280024 [PubMed]

PMCID: PMC4533840


EC Neurology
Identifying Key Symptoms Differentiating Myalgic Encephalomyelitis and Chronic Fatigue Syndrome from Multiple Sclerosis

PMID: 28066845 [PubMed]

PMCID: PMC5214344


EC Pharmacology and Toxicology
Paradigm Shift is the Normal State of Pharmacology

PMID: 28936490 [PubMed]

PMCID: PMC5604476


EC Neurology
Examining those Meeting IOM Criteria Versus IOM Plus Fibromyalgia

PMID: 28713879 [PubMed]

PMCID: PMC5510658


EC Neurology
Unilateral Frontosphenoid Craniosynostosis: Case Report and a Review of the Literature

PMID: 28133641 [PubMed]

PMCID: PMC5267489


EC Ophthalmology
OCT-Angiography for Non-Invasive Monitoring of Neuronal and Vascular Structure in Mouse Retina: Implication for Characterization of Retinal Neurovascular Coupling

PMID: 29333536 [PubMed]

PMCID: PMC5766278


EC Neurology
Longer Duration of Downslope Treadmill Walking Induces Depression of H-Reflexes Measured during Standing and Walking.

PMID: 31032493 [PubMed]

PMCID: PMC6483108


EC Microbiology
Onchocerciasis in Mozambique: An Unknown Condition for Health Professionals.

PMID: 30957099 [PubMed]

PMCID: PMC6448571


EC Nutrition
Food Insecurity among Households with and without Podoconiosis in East and West Gojjam, Ethiopia.

PMID: 30101228 [PubMed]

PMCID: PMC6086333


EC Ophthalmology
REVIEW. +2 to +3 D. Reading Glasses to Prevent Myopia.

PMID: 31080964 [PubMed]

PMCID: PMC6508883


EC Gynaecology
Biomechanical Mapping of the Female Pelvic Floor: Uterine Prolapse Versus Normal Conditions.

PMID: 31093608 [PubMed]

PMCID: PMC6513001


EC Dental Science
Fiber-Reinforced Composites: A Breakthrough in Practical Clinical Applications with Advanced Wear Resistance for Dental Materials.

PMID: 31552397 [PubMed]

PMCID: PMC6758937


EC Microbiology
Neurocysticercosis in Child Bearing Women: An Overlooked Condition in Mozambique and a Potentially Missed Diagnosis in Women Presenting with Eclampsia.

PMID: 31681909 [PubMed]

PMCID: PMC6824723


EC Microbiology
Molecular Detection of Leptospira spp. in Rodents Trapped in the Mozambique Island City, Nampula Province, Mozambique.

PMID: 31681910 [PubMed]

PMCID: PMC6824726


EC Neurology
Endoplasmic Reticulum-Mitochondrial Cross-Talk in Neurodegenerative and Eye Diseases.

PMID: 31528859 [PubMed]

PMCID: PMC6746603


EC Psychology and Psychiatry
Can Chronic Consumption of Caffeine by Increasing D2/D3 Receptors Offer Benefit to Carriers of the DRD2 A1 Allele in Cocaine Abuse?

PMID: 31276119 [PubMed]

PMCID: PMC6604646


EC Anaesthesia
Real Time Locating Systems and sustainability of Perioperative Efficiency of Anesthesiologists.

PMID: 31406965 [PubMed]

PMCID: PMC6690616


EC Pharmacology and Toxicology
A Pilot STEM Curriculum Designed to Teach High School Students Concepts in Biochemical Engineering and Pharmacology.

PMID: 31517314 [PubMed]

PMCID: PMC6741290


EC Pharmacology and Toxicology
Toxic Mechanisms Underlying Motor Activity Changes Induced by a Mixture of Lead, Arsenic and Manganese.

PMID: 31633124 [PubMed]

PMCID: PMC6800226


EC Neurology
Research Volunteers' Attitudes Toward Chronic Fatigue Syndrome and Myalgic Encephalomyelitis.

PMID: 29662969 [PubMed]

PMCID: PMC5898812


EC Pharmacology and Toxicology
Hyperbaric Oxygen Therapy for Alzheimer's Disease.

PMID: 30215058 [PubMed]

PMCID: PMC6133268


News and Events


October Issue Release

We always feel pleasure to share our updates with you all. Here, notifying you that we have successfully released the October issue of respective journals and can be viewed in the current issue pages.

Submission Deadline for November Issue

Ecronicon delightfully welcomes all the authors around the globe for effective collaboration with an article submission for the November issue of respective journals. Submissions are accepted on/before October 31, 2020.

Certificate of Publication

Ecronicon honors with a "Publication Certificate" to the corresponding author by including the names of co-authors as a token of appreciation for publishing the work with our respective journals.

Best Article of the Issue

Editors of respective journals will always be very much interested in electing one Best Article after each issue release. The authors of the selected article will be honored with a "Best Article of the Issue" certificate.

Certifying for Review

Ecronicon certifies the Editors for their first review done towards the assigned article of the respective journals.

Latest Articles

The latest articles will be updated immediately on the articles in press page of the respective journals.

Immediate Assistance

The prime motto of this team is to clarify all the queries without any delay or hesitation to avoid the inconvenience. For immediate assistance on your queries please don't hesitate to drop an email to editor@ecronicon.uk