■Steven-Johnson综合征(SJS)是一种罕见且严重的多形性红斑渗出性。SJS中的多系统参与以及对暴露于麻醉药物的疾病沉淀的怀疑使麻醉成为一项具有挑战性的任务。麻醉期间的关注点是粘膜病变和需要特殊护理,以防止在气道管理期间对口咽和喉造成伤害,以及用于麻醉的药物。在文学中,很少有孤立病例报告或病例系列。这里,我们分析了SJS来进行眼科麻醉的病例,考虑到表达方式等因素,沉淀因素,相关疾病,麻醉类型,麻醉修改,麻醉期间使用的各种药物。
■回顾性分析了在18个月内需要眼科检查或手术(局部或全身麻醉)等干预措施的497例SJS患者的电子病历。对记录进行了审查,以获得相关细节,如麻醉剂,肌肉松弛剂,吸入剂,和镇痛药.还注意到与监测和插管有关的问题。对数据进行分析并以频率和百分比表示。
■患者年龄介于9个月至72岁之间。许多手术是在全身麻醉下进行的(441),尽管少数手术需要局部(球周阻滞)麻醉(56)。用于全身麻醉的药物为七氟醚,异氟烷,异丙酚,硫喷酮,维库溴铵,阿曲库铵和用于疼痛管理的药物是芬太尼,曲马多,布托啡诺,和扑热息痛.对非甾体抗炎药(NSAIDs)和扑热息痛敏感的患者未给予相同的治疗。没有患者对用于麻醉的不同药物有不利反应。
■找出促成因素,了解病理生理学及其对麻醉的影响将有助于在罕见的SJS病例中成功管理麻醉。
UNASSIGNED: Steven-Johnson Syndrome (SJS) is a rare and severe form of erythema exudative multiforme. Multisystem involvement in SJS and the suspicion of precipitation of the disease with exposure to anesthetic drugs makes anesthesia a challenging task. The concerns during anesthesia are the mucosal lesions and special care that is required to prevent injury to the oropharynx and larynx during airway management and also the drugs used for anesthesia. In the literature, very few isolated case reports or case series are available. Here, we have analyzed the cases of SJS coming for ophthalmic anesthesia, taking into consideration factors like mode of presentation, precipitating factors, associated diseases, types of anesthesia, anesthetic modifications, and various drugs used during anesthesia.
UNASSIGNED: The electronic medical records of 497 cases of SJS who required interventions like ophthalmic examination or surgery (either under local or general anesthesia) over a period of 18 months were analyzed retrospectively. The records were reviewed to obtain the concerned details like anesthesia-inducing agents, muscle relaxants, inhalational agents, and analgesics. The problems concerned with monitoring and intubation were also noted. The data were analyzed and presented as frequency and percentage.
UNASSIGNED: Patient age ranged between 9 months and 72 years. Many surgeries were conducted under general anesthesia (441) although a few required local (peribulbar block) anesthesia (56). The drugs administered for general anesthesia were sevoflurane, isoflurane, propofol, thiopentone, vecuronium, and atracurium and those administered for pain management were fentanyl, tramadol, butorphanol, and paracetamol. The patients who were sensitive to nonsteroidal anti-inflammatory drugs (NSAIDs) and paracetamol were not administered the same. None of the patients reacted adversely to the different drugs used for anesthesia.
UNASSIGNED: Identifying the precipitating factors, understanding the pathophysiology and its implications for anesthesia will help in successfully managing anesthesia in the rare cases of SJS.