Caesarean delivery in a pregnant woman with epidermolysis bullosa: anaesthetic challenges.

Epidermolysis bullosa is a heterogeneous group of hereditary diseases characterised by extreme fragility of skin and mucosa, with blister and lesion formation spontaneously or in response to trauma. Anaesthetic management of these patients is challenging with respect to positioning, monitoring, use of medical devices and airway management. These challenges are increased when managing labour. We report an elective caesarean delivery in a nulliparous woman with autosomal recessive dystrophic epidermolysis bullosa, managed successfully with spinal anaesthesia.

Morphine patient controlled analgesia for postoperative analgesia in patients who have transplanted cadaver donor kidneys.

INTRODUCTION: Patients who have chronic renal disease present challenges to anesthesiologists because of the sequelae of the underlying disease. Postoperative pain is usually mild to moderate after renal transplantation and is a concern because of underlying co-morbidities and variable responses of the graft. Effective postoperative pain management contributes to a a successful outcome after renal transplantation. METHODS: A retrospective study, based on the collected data from clinical process and registration of the acute pain unit. RESULTS: During 2007 and 2008, 124 patients were transplanted with cadaver donor kidneys. The final sample included 55 patients, namely 67% males and 33% females, whose ages range between 15 and 75 years (average, 47.23 years). Their American Society of Anesthesiologists physical status classification was 4 in 71% and 3 in 29%. Analgesia during surgery used a fentanyl, paracetamol and morphine protocol (n = 47) or fentanyl, paracetamol, morphine, and local anesthetic infiltration (n = 8). The postoperative pain was quantified using a numerical rating scale (0-4) with mean value of 1.07 on day 1, a mean value of 1 on day 2, and a mean value of 0.67 on day 3. Postoperative analgesia with morphine patient-controlled analgesia was used for every patient, combined with paracetamol in 89% of cases. The average number of bolus demands was 60 with 26.4 effective boluses, the mean total administered dose was 26.6 mg. The major side effects were constipation (18%), pruritus (14%), nausea (13%), and vomiting (1.8%). The following relations were significance: age and score of pain, pruritus and total dose of morphine, preoperative analgesia, and pain score on day 2. CONCLUSIONS: Our results suggest that analgesia with morphine patient-controlled analgesia was an effective method to achieve control of postoperative pain in this population with few side effects.