Clinical pearls in anesthesia for excision and reconstructive surgery for cauliflower carcinoma on psoriatic plaques

Abstract

Meticulous preoperative evaluation and planning is essential in psoriasis patients presenting for surgery as the airway and axial skeleton may both be involved in addition to extensive integumentary involvement. Difficult airway as well as difficult neuraxial block may be encountered due to psoriatic arthropathy. Widespread skin lesions may not spare free space for intravenous cannulation, invasive arterial/central venous lines, spinal/epidural block, and electrode placement for electrocardiogram, bispectral index, or peripheral nerve stimulator. Noninvasive techniques such as pleth variability index for guiding fluid therapy are encouraged to avoid instrumentation induced fresh psoriatic lesions. Psoriasis therapy (steroids, methotrexate, psoralens, and antidepressants) has side effects including malignant transformation of multiple psoriatic plaques which merit consideration. Drugs known to aggravate psoriasis (benzodiazepines, clonidine, beta blockers, and nonsteroidal anti-inflammatory drugs) and slightest trauma to skin need to be avoided. Anesthetic challenges in a psoriatic patient and their successful management have been described here.