Cantallops Pericas B, Galán Serrano J, Unzueta Merino M C, Villar Landeira J M
Servicio de Anestesiología, Reanimación y Terapia del Dolor, Hospital de la Santa Creu y Sant Pau, Facultad de Medicina, Universidad Autónoma de Barcelona.
Rev Esp Anestesiol Reanim. 1991 Jan-Feb;38(1):48-50.
We report the clinical case of a 56 years old male suffering dystrophic ampullar epidermolysis. He underwent brachial plexus blockade to remove a right hand tumor. The patient presented bilateral pseudosyndactylia, flexion retraction of the left hand, and erosive lesions in the inferior extremities, forearm, and trunk interfered monitorization and venous catheterization. Cutaneous friction or trauma should be carefully avoided since in this patient might produce detachment of the epidermis and subsequent ampullar formation. Cutaneous electrodes without adhesive components, padded sphygmomanometers, ear pulsimeter, and venous catheter sutured to the skin were used during monitorization. Anesthetic management of patients with dystrophic ampullar epidermolysis should consider careful airway manipulation, reduction of mucocutaneous contacts, prevention of pressure or friction skin trauma, appropriate electrolyte and plasma volume reposition, and use of nonadhesive material. To avoid airway manipulation regional anesthesia should be considered in patients with ampullar epidermolysis. We recommend regional anesthesia with ketamine.
我们报告了一例56岁男性患有营养不良性壶腹型表皮松解症的临床病例。他接受了臂丛神经阻滞以切除右手肿瘤。患者出现双侧假性并指畸形、左手屈曲挛缩，下肢、前臂和躯干的糜烂性病变干扰了监测和静脉置管。应小心避免皮肤摩擦或创伤，因为在该患者中可能会导致表皮脱落及随后的壶腹形成。监测期间使用了无粘性成分的皮肤电极、带衬垫的血压计、耳部脉搏计以及缝合至皮肤的静脉导管。对患有营养不良性壶腹型表皮松解症的患者进行麻醉管理时，应考虑谨慎的气道操作、减少粘膜皮肤接触、预防压力或摩擦性皮肤创伤、适当补充电解质和血浆容量以及使用无粘性材料。为避免气道操作，对于患有壶腹型表皮松解症的患者应考虑采用区域麻醉。我们推荐使用氯胺酮进行区域麻醉。
