hEDS Guide to Prepping for Surgery

When it comes to surgery, individuals with hypermobility can benefit from extra care and consideration to accommodate our unique anatomy and physiology. Surgery can be scary enough, but having to worry about other wonky side effects brings in added stress. The purpose of this guide is to walk you through some common concerns when it comes to EDS/HSD in a surgical context, and recommendations or ideas to help modify and support your body. This list is not exhaustive, nor is it prescriptive. Every hypermobile body is different, every surgery and surgical team is different. Instead, this is meant to be an outline that you can review for yourself, and bring to your team to discuss best options.

As always, I've included references for data, because evidence based practiced helps get medical teams on the same page.

1) Bring documentation of your diagnosis, and make sure your care team is aware going into the surgery.

• Bring documentation of your diagnosis, including letters from your care team, or bring it up during your pre surgical discussion meeting.

• Have members of your pre-existing care team write letters concerning surgical risks that are unique to you that you can bring to pre-surgery discussion meetings.

• Discuss your hypermobility with your surgical team, or schedule a separate meeting entirely to make sure your needs are addressed.

2) Check with your physician team about local anesthesia options. People with hypermobility have reduced numbing sensation and reduced duration of efficacy with lidocaine.

As of 2026, we have evidence that individuals with hEDS respond differently to lidocaine. We actually have studies from the 1990s confirming that the numbing of lidocaine also achieves less depth, not just a smaller topical area, so is overall, not an effective local numbing agent.

• Ask for articaine, bupivacaine, or another topical instead of lidocaine.

• If you have experienced anesthesia failure or inefficacy, make sure it's documented in your medical record.

• Consider regional blocks or general anesthesia for larger procedures.

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3) Protect your joints. Communicate with your care team and request to utilize braces, or positional assist during operations. There's data out there that joint movement and manipulation under general anasthesia can result in injuries to patients, so it's important to make sure that your team moves your body with care while you're under. That might mean talking through the surgery with them extensively, and discussing strategies to avoid hyper-extension.

•  Consider a neck collar to avoid extreme ranges of motion during surgery that may occur with positional changes.

• Utilize familiar braces on joints that have a history of instability.

• Ask to be oriented horizontally, rather than strapped vertically or at an incline to a table.

• Talk through with your nursing staff. These people can be great allies when they're informed.

• Self position for general anesthesia!

  1) PMID: 25053156

  
  

4) Protect your neck.

• Ask for smaller endotracheal tubing when getting general anesthesia, or camera guided intubation. This reduces the risk of damaging the throat and larynx. People with hypermobility often have more sensitive tissues and are at a higher risk of bleeding. A smaller tube poses a lower risk, and camera guided can insure that they are more careful of your tissue.

• Ask for your team to double check your positioning and make sure your cervical spine is neutral. A soft or hard collar can be really helpful here. What we want to avoid is hyper-extending the upper cervical spine for extended periods of time.

  
  

5) Ask for extra padding. Because of the nature of hypermobility, our connective tissues are more delicate. That means compression injuries, which can occur during prolonged periods of pressure on tissue, are more likely.

1) Ask for extra padding in areas that are more sensitive

2) Ask for extra padding if joints need to be supported or elevated to reduce risk of compression injuries, including the base of the skull.

6) Ask for easily removable adhesives, tapes, glutes, anything sticky. Especially for certain types of EDS, the removal of this adhesive can actually rip the skin, or reopen the incision.

1) Surgical tape should be easy to remove

2) Ask for any tape used for intubation to have reduced stickiness, or used in smaller amounts.

3) Wound dressings should also use tape or adhesives that are appropriate for fragile skin.

7) If you have MCAS, request your care team avoid histamine-releasing drugs during anaesthesia.

• To name a few, atracurium, mivacurium, nefopam. These muscle relaxers are quite commonly included in general anesthesia.

• With MCAS, we can sometimes react to new things, so ask for preservative-free preparations when possible to reduce the risk of reaction.

• Continue whatever anti-histmaines you can prior to surgery

• Maintain a more conservative low histamine approach (specific to you) in the days prior to surgery to reduce histmaine load.