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

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.


Research on hypermobility and Ehlers-Danlos Syndromes is far behind other medical diagnoses. It takes the voice of the patient and the support of the community to fund research projects that will allow increased awareness, development of diagnostic criteria and evidence-based treatment protocols.

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