Successful use of ketamin combined with remifentanil in two patients with epidermolysis bullosa

Yıl 2012, , 395 - 397, 01.09.2012

İlker Öngüç Aycan Aysun Ankay Yılbaş Sennur Uzun Özgür Canbay Turgay Öcal Saadet Özgen

https://doi.org/10.5799/ahinjs.01.2012.03.0186

Öz

Epidermolysis Bullosa (EB) is characterized by the presence of extremely fragile skin and painful blister formations in the skin. We present the anesthetic management of 15-years-old, twin sisters with EB during the syndactyly operation. Premedication was done with 0.5 mg/kg nasal midazolam. Anesthesia induction was performed with sevoflurane without touching the facial masks to the skin. After intravenous 2 mgkg-1 ketamine and 50 μg fentanyl, anesthesia was maintained by intravenous 1 mg/kg/hr ketamine and 0.1 μg/kg/min remifentanil. We injected 2 mg intravenous morfin for postoperative pain control. Ketamine with remifentanil seems to be effective, simple, and safe for airway management and practical way to provide general anesthesia and analgesia of EB.

Anahtar Kelimeler

Epidermolysis bullosa, ketamin, remifentanil, anesthesia

Successful use of ketamin combined with remifentanil in two patients with epidermolysis bullosa

Öz

Epidermolizis bülloza (EB) aşırı hassas cildin oluşu ve ciltte ağrılı sıvı kabarcıkları oluşumuyla karakterizedir. Epidermolizis bülloza\'lı 15 yaşında ikiz kız kardeşlerin sindaktili operasyonu sırasındaki anestetik yaklaşımımızı sunuyoruz. Premedikasyon 0.5 mg kg-1 nasal midazolam ile yapıldı. Yüz maskesi cilde temas ettirilmeden anestezi indüksiyonu sevofluran ile yapıldı. İntravenöz 2 mgkg-1 ketamine and 50 μg fentanyl veridikten sonra, intravenöz 1 mgkg-1st-1 ketamine and 0.1 μg/kg/dk remifentanil ile anestezi idamesi yapıldı. Postoperatif ağrı kontrolü için 2 mg intravenöz morfin uygulandı. Remifentanil ile ketamin EB\' nın genel anestezi ve analjezi uygulaması için pratik bir yol ve hava yolu yönetiminde etkili, basit ve güvenli olarak gözükmektedir.

Anahtar Kelimeler

Epidermolizis bülloza, ketamin, remifentanil, anestezi

Kaynakça

• Lin YC, Golianu B. Anesthesia and pain management for pediatric patients with dystrophic epidermolysis bullosa. J Clin Anesth 2006;18(4):268-71.
• Wu J. Deep sedation with intravenous infusion of com- bined propofol and ketamine during dressing changes and whirlpool bath in patients with severe epidermoly- sis bullosa. Paediatr Anaesth 2007;17(6):592-6.
• Hallel-Halevy D, Nadelman C, Chen M, Woodley DT. Epidermolysis bullosa acquisita: update and review. Clin Dermatol 2001;19(6):712-8.
• Herod J, Denyer J, Goldman A, Howard R. Epider- molysis bullosa in children: pathophysiology, an- aesthesia and pain management. Paediatr Anaesth 2002;12(5):388-97.
• Ames WA, Mayou BJ, Williams KN. Anaesthetic management of epidermolysis bullosa. Br J An- aesth1999;82(5):746-51.
• James I, Wark H. Airway management during anesthe- sia in patients with epidermolysis bullosa dystrophica. Anesthesiology 1982;56(4):323-6.
• Baloch MS, Fitzwilliams B, Mellerio J, et al. Anaesthetic management of two different modes of delivery in pa- tients with dystrophic epidermolysis bullosa. Int J Ob- stet Anesth 2008;17(2):153-8.