Table 7.

Patient management in the operating theater

Procedure	Measures to be adopted
Operating table	• Place an anti-decubitus mattress and cushion on the table
	• Use the sheet to lift the infant and move him/her to the operating table; older patients should move themselves
	• Pad trauma-exposed sites (e.g. chin, occiput, elbows, heel, hands, feet)
Premedication	• Administer oral premedication 45 minutes prior surgery in order to reduce/prevent:
	✓ Patient anxiety (midazolam 0.5 mg/kg)
	✓ Oral secretion (atropine 40 mcg/kg)
	✓ Gastro-esophageal reflux (ranitidine 1 mg/kg)
	✓ Vomiting (metoclopramide 150 mcg/kg)
	• Prefer intravenous induction in presence of intravenous line, otherwise inhalational anaesthesia. In the latter case, protect the face from the mask with silicon foam (e.g. Mepilex®) or a water-based lubricant.
	• Protect the eyes with a moisturizing ophthalmologic gel and the eyelids with moistened gauzes
Patient monitoring	• Use tape with a silicon contact layer (Mepitac®) to fixe all tubes (e.g. endotracheal tube) and catheters
	• Lubricate all tubes with a water-based lubricant
	• Remove the adhesive part of electrodes allowing only the lubricated central portion to be in contact with the skin; then secure with a non adhesive dressing (e.g. Mepilex ®)
	• Use clip sensors for pulse oximetry
	• Use a lubricated disposable thermometer
	• Pad the skin with cotton or advanced dressings under the blood pressure cuff
	• Use bipolar diathermy to avoid a monopolar pad
	• Avoid carefully all kinds of trauma and friction for the entire duration of surgery
Intubation	• Evaluate microstomia, esophageal strictures and prominent incisors in RDEB* patients who need intubation
	• Prefer fiberoptic-assisted intubation to laryngoscopy in case of difficult intubation
Recovery room	• Administer a moderate sedation before emergence to avoid cutaneous lesions due to irritability
	• Perform tracheal aspiration gently using soft and small tubes

*RDEB, recessive dystrophic epidermolysis bullosa.