Anesthetic management of epidermolysis bullosa : a review and report of two cases

Dystrophic epidermolysis bullosa is a rare genetically mechanobullous disorder, characterized by an excessive susceptibility of the skin and mucosa to separate from the underlying tissues after mechanical trauma. Avoiding mechanical stimulation of the skin and mucous membranes is essential in the anesthetic management. These case reports describes bilateral nerve block in two patients with an anticipated airway difficulty due to epidermolysis bullosa. We report the successful applications of intraoperative indirect electrocardiogram monitoring without electrodes and bilateral axillary and midhumeral nerve block using levobupivacaine in combination with lidocaine in patients who had previously undergone repeated general anesthesia. We conclude that regional anesthesia should be preferred in patients with dystrophic epidermolysis bullosa, especially those who had previously undergone repeated general anesthetic procedures.