[Anesthetic management of a patient with pemphigoid for prosthetic replacement after femoral neck fracture].

We report an 83 year-old male with pemphigoid who underwent replacement of a femoral neck prosthesis following femoral neck fracture. Problems associated with anesthetic management of patients with vesiculobullous diseases such as pemphigoid include fluid, electrolyte and protein loss, and secondary infection because of the fragility of the skin and mucous membranes. Avoidance of trauma to the skin and mucous membranes is therefore important. Intubation of the trachea may be hazardous because of the possibility of airway obstruction resulting from oropharyngeal and laryngeal bullae. The patient was successfully anesthetized with spinal anesthesia using 2.5 ml of tetracaine in a 0.4% solution of 0.45% NaCl. An evacutable mattress was used to protect the patient from pressure points in the lateral position, and to minimize the hazards from pressure by spreading the weight. Surgery proceeded uneventfully and the postoperative period was uncomplicated.