Manejo anestésico en paciente pediátrico con vía aérea difícil afectado de epidermólisis ampollosa distrófica

Clinical practice guidelines: Oral health care for children and adults living with epidermolysis bullosa

“…The discussion usually includes risks, benefits, advantages, and disadvantages of each technique, as well as the alternatives based on what is available in the local specialized services. There are many factors that can influence the final decision such as the patient's age, 3 extent of dental treatment required, 3,4 and the patient's acute stress reaction 3 . It is important to highlight that sedation should only be performed if all the expertise and resources for emergency access of critical airway are available.…”

“…Access to the working area will remain a challenge (Image 5.3). 4,22 Some authors recommend combined procedures using the same general anesthesia jointly with other surgical specialities, 23 eg, esophageal dilatation 20 and bandage changes after hand surgery 4 . The risk of transient bacteremia due to dental treatment should be discussed among surgical teams to decide whether it is possible to combine specific procedures.…”

“…All of these challenges increase the risk of regurgitation and aspiration during anesthesia. In addition, as an intraoperative complication, there is the risk of acute airway obstruction due to oropharyngeal bulla development while manipulating the airway 4 . The best practice is to work as part of a multidisciplinary group with dermatologists, surgeons, and nurses caring for patients with EB under general anaesthesia 15 …”

“… Adhesives should be avoided if possible 3,4,15,25–27 . If silicone‐based adhesives are not available, minimally adherent products and adhesive remover could be tried.…”

“…If the eyelids can be closed normally, the eyes should be lubricated with an ophthalmic gel such as sodium hyaluronate 2 mg/mL and draped with a nonadherent dressing under the head drapes (Image 5.7). If silicone‐based bandages are not available, a soft moisture gauze can be used 3,4,22,30 . If there is lagophthalmos, the eyes need to be thoroughly lubricated.…”