Anesthetic management of a known case of pemphigus vulgaris with diabetes mellitus posted for surgery

Abstract

80 yr old diabetic female known case of pemphigus vulgaris, got admitted to our hospital with relapse of fresh lesions. During her hospital stay she fell down in the washroom and developed fracture in inter-trochanteric region of left femur for which surgery was planned. She had pancytopenia, low hemoglobin level, low platelet count and deranged blood sugar levels. After optimization she was planned for surgery under spinal anesthesia. Special care was taken during transfer, positioning, placement of intravenous lines and monitors. She was premedicated with intravenous steroids. Part was painted gently with chlorhexidine & spinal anesthesia was administered using hyperbaric bupivacaine with a 26 gauge Quincke’s needle taking care not to puncture the blisters and papules. Pressure points were adequately padded. Intra-operative hemodynamics were stable. Post-operatively, care was taken for the existing lesions along with special care to prevent the development of fresh lesions.