Prepare for Surgery

Certain precautions can improve outcomes

Prepare yourself and surgical team for surgery

The Tulane Hypermobility and Ehlers-Danlos Syndrome (EDS) clinic team is here to help prevent surgical complications in patients with Ehlers-Danlos syndrome. The most common complications that we have noticed involve prolonged wound healing and scar tissue formation around the surgical site or intra-abdominal. Co-morbidities common with EDS include POTS, mast cell activation spectrum disorders (anaphylaxis, allergies to medications) and complex regional pain syndrome. Here are a few tips to help prevent complications when performing a surgical procedure on a patients with Ehlers-Danlos Syndrome.

  • Alert your surgical team that you have Ehlers-Danlos Syndrome (EDS)

  • Print out this journal article and give to your surgeon

  • More local anesthetic may need to be used

  • Avoid tourniquets, or decrease tourniquet time if possible.

  • More general anesthesia may be needed

  • EDS patients tend to have a higher rate of medication allergies.

  • Consider an echocardiogram prior to surgery

  • Avoid extreme/prolonged patient positioning

  • Consider using suture/adhesive strips combination technique for skin closure.

Potential risks in patients with Ehlers-Danlos Syndrome

  • Unstable C spine
  • TMJ dislocation/subluxation
  • Neurologic injury/compression
  • Occipitalatlantoaxial instability, cervical instability (recommend pre-op cervical flexion and extension x-rays)
  • Fragile mucosa/skin, (decreased)
  • Lung injury/pneumothorax/shunt with PPV
  • Increased risk of ocular injury, arterial/intestinal rupture
  • Increased risk of poor wound healing
  • Increased risk of hypotension/orthostasis secondary to dysautonomia (POTS), may need aggressive IV fluid use
  • Opiates may not be effective. Consider high dose Tylenol, tramadol, neuropathic agents.
  • Allergic reactions are common due to mast cell dysfunction. Consider pre-treatment with antihistamines/steroids.
  • Aggressively manage pain.
  • Benzodiazepines are helpful (stabilize mast cells).
  • Gastroparesis. Aggressively use laxatives and optimize blood pressure.

Helpful peri-operative consultants: Immunology, cardiology, plastic surgery, local EDS-specialist

Helpful peri-operative labs/tests: echocardiogram, orthostatics/flexion-extension cervical spine x-rays

Check out other resources on our site, or other great information from the Ehlers-Danlos Society.

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