Bilge Tuncer Ezgi Erkılıç Gurkan Ilhan Merve Akin Orhan Kanbak

Keywords: Anesthesia, COVID-19, Toxic epidermal necrolysis, Vaccine

Abstract

Toxic epidermal necrolysis (TEN), is an acute, life-threatening emergent disease involving the skin and mucous membranes with serious systemic complications. It is characterized by widespread epidermal sloughing. Drugs are the most common triggers of TEN, but infection, vaccination, radiation therapy and malignant neoplasms can all induce it in susceptible patients. We report two cases in whom a hair dye and a COVID-19 vaccine (BioNTech®, Pfizer) were believed to be the causative agents. These patients have to undergo repeated debridements of the necrotic tissue. In this manuscript the anesthetic management of TEN patients is discussed. Detailed preoperative evaluation, aggressive fluid and electrolyte replacement, avoidance of hypothermia during debridement, minimizing anesthetic agents and limiting traumatic procedures are key points in the management.

Abbreviations: BUN: blood urea nitrogen; BSA: Body surface area; Cr: Creatinine; OR: Operating room; SJS: Stevens-Johnson Syndrome; TEN: Toxic epidermal necrolysis

Key words: Anesthesia; COVID-19; Toxic epidermal necrolysis; Vaccine

Citation: Bilge B, Erkilic E, İlhan G, Akin M, Kanbak O. Anesthetic management of toxic epidermal necrolysis: a report of two cases. Anaesth. pain intensive care 2022;27(1):135−138; DOI: 10.35975/apic.v27i1.2113

Received: November 22, 2022; Reviewed: November 29, 2022; Accepted: December 02, 2022

Author Biographies

Bilge Tuncer

MD, Department of Anesthesiology and Intensive Care, Ankara City Hospital, Ankara, Turkey

Ezgi Erkılıç

Associate Professor in Anesthesiology, Department of Anesthesiology and Intensive Care, Ankara City Hospital, Ankara, Turkey

Gurkan Ilhan

MD, Department of Anesthesiology and Intensive Care, Ankara City Hospital, Ankara, Turkey

Merve Akin

Associate Professor in General Surgery, Department of General Surgery, Burn Treatment Center, Ankara City Hospital, Ankara, Turkey

Orhan Kanbak

Professor in Anesthesiology, Department of Anesthesiology and Intensive Care, Ankara City Hospital, Ankara, Turkey