Englbrecht J S, Langer M, Hahnenkamp K, Ellger B
Department of Anaesthesiology and Intensive Care Medicine, Muenster University Hospital, Muenster, Germany.
Anaesth Intensive Care. 2010 Nov;38(6):1101-5. doi: 10.1177/0310057X1003800623.
We report the use of ultrasound-guided axillary brachial plexus block in a child with dystrophic epidermolysis bullosa needing surgical treatment of the right hand. The regional anaesthesia was used in association with sedation/ anaesthesia. This technique is suitable for these difficult patients because it can minimise the risk of new bullae formation due to palpation of landmarks or unintentional intra- or subcutaneous injections. Initial anaesthesia/sedation was provided with sevoflurane until intravenous access was obtained, following which intravenous propofol infusion with ketamine boluses without any invasive airway management was continued for performance of the block and the procedure. This management plan provided good surgical conditions, early postoperative analgesia, minimised stress for the patient and avoided the need to manipulate the airway with instruments and the associated risk of mucosal bullae. The classification and breadth of clinical manifestation of epidermolysis bullosa is complex and briefly summarised. The anaesthetist should clarify the details of a particular patient's form of epidermolysis bullosa, especially in terms of mucosal involvement, as this may greatly influence planning for a procedure.
我们报告了在一名患有营养不良性大疱性表皮松解症且需要对右手进行手术治疗的儿童中使用超声引导下腋路臂丛神经阻滞的情况。区域麻醉与镇静/麻醉联合使用。该技术适用于这些病情复杂的患者，因为它可以将因触摸体表标志或意外的肌内或皮下注射导致新水疱形成的风险降至最低。最初使用七氟醚进行麻醉/镇静，直至建立静脉通路，之后在不进行任何有创气道管理的情况下，持续静脉输注丙泊酚并推注氯胺酮，以进行神经阻滞和手术操作。该管理方案提供了良好的手术条件、早期术后镇痛，将患者的应激降至最低，并且避免了使用器械操作气道以及相关的黏膜水疱风险。大疱性表皮松解症的临床表现分类和范围较为复杂，在此进行简要总结。麻醉医生应明确特定患者大疱性表皮松解症的具体类型细节，尤其是黏膜受累情况，因为这可能会极大地影响手术方案的制定。
