A six year old male child, weighing 18 kg was referred to Department of Anasethesia, Byramjee Jeejeebhoy Government Medical College and Sassoon General Hospitalfor excision of ulceroproliferative lesion of upper lip. Lesion was 2.5×2 cm in size arising from angle of mouth for last one month (Fig.1). Patient is a known case of Xeroderma Pigmentosum (XP) since one year of age. He had extensive hyperpigmented macular as well as raised skin lesions in sun exposed areas along with diminution of vision in both eyes secondary to corneal opacity and keratomalacia. Physical examination of child was unremarkable. Preoperative blood investigations were within normal limits. Standard preoperative monitors were attached. Intravenous access was secured gently. Patients head, neck, trunk and extremities were covered with linen before turning the operation theatre lights on. Lesion was covered with sterile gauze prior to face mask ventilation to avoid trauma. General anaesthesia was induced with intravenous midazolam 0.5 mg, fentanyl 40 mcg, propofol 40 mg followed by I-gel no. 2 insertion (Fig. 2). Use of muscle relaxant was avoided. Anaesthesia was maintained with O and 2 propofol infusion along with assisted ventilation via circle absorber. Lubricating eye drops were instilled before patching the eyes. Local infiltration of surgical site was done with 0.25% bupivacaine 3 ml. Intraoperative course was uneventful. iGEL was removed after effortless spontaneous breathing. Postoperative analgesia maintained with appropriate dose of diclofenac and tramadol. Paracetamol was avoided as analgesic. Histopathology of lesion confirms basal cell carcinoma of lips.
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