Anaesthetic management of a patient with pemphigus vulgaris for emergency laparotomy

A 45-year-old man with a long-standing history of duodenal ulcer presented with symptoms and signs of perforation peritonitis. He also had lesions of pemphigus vulgaris throughout the body, involving both skin and mucous memb ranes. Care was taken to avoid pressure and friction during placement of mo nitoring devices, intravenous and arterial lines. Since the patient had to undergo exploratory laparotomy, intubation was performed in an atraumatic m anner after rapid sequence induction. However, there was minor bleeding fro m the mucous lesions of the oral cavity, which was controlled by a saline a drenaline throat pack. The patient was extubated at the end of the surgery and steroids were continued in the peri-operative period.