Spinal Anesthesia to Avoid Airway Manipulation in Epidermolysis Bullosa: A Case Report

Epidermolysis bullosa (EB) is a rare group of inherited disorders characterized by mucocutaneous blistering after minimal trauma; in dystrophic subtypes, squamous cell carcinoma (SCC) arising from chronic wounds is a serious complication.We report spinal anesthesia for wound biopsy in a 22-year-old woman with EB and SCC receiving chemotherapy, in whom a previously reported laryngeal mask airway-related airway event shaped the anesthetic plan.As the patient reported prior airway swelling and declined general anesthesia, airway instrumentation was avoided.Spinal anesthesia was performed in the sitting position at L4-5 with a 25 G Quincke needle and intrathecal 10 mg hyperbaric bupivacaine plus 10 µg fentanyl; no sedation was given, and the patient breathed room air spontaneously.Skin-preserving modifications were applied: dabbing antisepsis without friction, omission of electrodes to avoid epidermal stripping, and placement of the blood pressure cuff over petrolatum-impregnated padding, while pulse oximetry and intermittent noninvasive blood pressure were maintained.With a T8 sensory level, back and foot biopsies were completed within two hours without vasopressors; hemodynamics remained stable, and no new blisters were noted at 24 hours.In selected adult EB patients with a complicated airway history, spinal anesthesia may be an alternative to general anesthesia.