Surgical Considerations with EDS

  1. Pre-operatively

    1. Pre-hydrate for a few days before the procedure

    2. Warn surgeon of special surgical considerations for patients with EDS

    3. Warn surgeon of joints that tend to sublux most frequently as they are more likely when under general anesthesia

  2. Positioning

    1. Avoid positions of extreme end range of motion (or hyperextension) to avoid subluxation/dislocation

    2. Avoid over-stretching nerves and tendons/ligaments that are already hypermobile and may stretch to end-range easier than most

    3. Rib subluxations common, careful not to hyperinflate lungs

  3. Anesthesia - common co-morbidities

    1. Common resistance and delayed onset to local anesthetic 

    2. Common to have tracheomalacia (consider fiber optic intubation)

    3. Temporomandibular Joint dysfunction

    4. Obstructive sleep apnea

    5. IV fluid loading would be helpful for POTS (to avoid likely hypovolemia)

    6. Careful with neuraxial blocks - tissue fragility and poor response to local anesthesia

    7. Opiods dosed intra-operatively may exacerbate already underlying nausea and gastroparesis

  4. Tissue sensitivity

    1. ECG leads - may not tolerate tape or removal may tear tissue

    2. Tape allergy common - paper tape best

    3. Tourniquets can tear tissue or cause excess rebound perfusion when released

    4. Consider allograft vs autograft for tissue reconstruction due to weakness of patient’s own tissue

  5. Sutures

    1. Place them closer together, consider multiple levels

    2. Should be placed without tension

    3. Should be left in longer than typical

    4. Consider monocryl vs vicryl sutures

  6. Cervical instability

    1. Intubation may be difficult

    2. Careful about positioning during airway placement

  7. GI

    1. Tendency for gastroparesis (opioids may increase chronic constipation)

    2. Organ prolapse

  8. Spine

    1. Segmental instability

    2. Tethered cord common

    3. CCI, AAI and cervical spine instability common

    4. Higher risk of post dural puncture headache

  9. Cardiovascular

    1. Easy bruising

    2. Tissue fragility

    3. MVP and AA more common

    4. Peripheral blood pooling

  10. Post-operatively

    1. May require more pain medication than typical patient due to resistance to local anesthesia

    2. Opioids have a tendency to release histamine which may further worsen MCAS response, blood pooling (hemo-dilation). Fentanyl or ketamine may be better for pain relief immediately post-op.

    3. Watch for MCAS response to tissue trauma

Citation: Chopra, P. and Bluestein, L. (2020), Perioperative Care in Patients with Ehlers Danlos Syndromes, Open Journal of Anesthesiology, 10, 13-29.

Disclaimer: Wendy4Therapy is not a medical doctor and is not licensed to provide an official medical diagnosis. Education provided here is for your information only, and it is expected that you visit a medical practitioner who is licensed to provide a diagnosis for further exploration. Wendy4Therapy can take you through the diagnostic criteria but cannot formally diagnose EDS or related conditions. Please do not reproduce without permission. This is GENERAL and not intended to be customized for individual patients. Please follow consultation and recommendations of your healthcare provider for specifics to your condition.