Anesthetic management and outcomes of patients with Steven-Johnson Syndrome-A retrospective review study.

BACKGROUND AND AIMS: 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. MATERIAL AND METHODS: 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. RESULTS: 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. CONCLUSION: Identifying the precipitating factors, understanding the pathophysiology and its implications for anesthesia will help in successfully managing anesthesia in the rare cases of SJS.

A randomized controlled prospective study comparing a low dose bupivacaine and fentanyl mixture to a conventional dose of hyperbaric bupivacaine for cesarean section.

CONTEXT: Hormonal and mechanical factors make obstetric patients need strict dose calculations of local anesthetics intrathecally for spinal anesthesia. Any greater dose of local anesthetics can cause hemodynamic instability, maternal morbidity and any lesser dose can produce inadequate block. Hence, we hypothesized in our study that by using low dose of bupivacaine with fentanyl can maintain stable hemodynamics and provide better analgesia. AIM: The aim was to compare the hemodynamics and duration of analgesia using a low dose (7.5 mg) bupivacaine fentanyl mixture to a conventional dose (10 mg) of hyperbaric bupivacaine for cesarean section. SETTINGS AND DESIGN: Double-blinded, randomized, controlled prospective study was conducted at a tertiary academic hospital from 2008 to 2011. MATERIALS AND METHODS: Fifty singleton parturient, scheduled for elective caesarean section were randomly allocated into two groups. Study group (group-S) received a combination of 25 µg fentanyl and 7.5 mg of hyperbaric bupivacaine, whereas the control group (group-C) received 10 mg of hyperbaric bupivacaine. Maternal hemodynamics, sensory and motor block, duration of analgesia and the Apgar score of the newborn were compared between the groups. STATISTICAL ANALYSIS USED: Observational descriptive statistics, statistical package for social sciences (SPSS Inc. Released 2006, SPSS for Windows, Version 15.0. Chicago), paired t-test was used as applicable. RESULTS: The blood pressure significantly decreased with >25% fall from the baseline in group-C (98.76 ± 8.36) than in group-S (117.32 ± 12.21) with P < 0.001. The duration of effective analgesia was significantly prolonged in the study group than in the control group (P < 0.001). CONCLUSION: The combination of low dose bupivacaine and fentanyl in comparison to bupivacaine alone is hemodynamically stable and prolonged duration of analgesia in caesarean section.

A double blind, randomized, controlled trial to study the effect of dexmedetomidine on hemodynamic and recovery responses during tracheal extubation.

BACKGROUND: The α2-adrenoreceptor agonist, dexmedetomidine, provides excellent sedation with minimal cardiovascular instability or respiratory depression and may be a useful adjunct to facilitate smooth tracheal extubation. MATERIALS AND METHODS: Fifty American Society of Anesthesiologists grade I-II patients, aged 20-45 years, scheduled for elective general surgical, urological and gynecological surgeries were studied after randomization into two groups. Group A and B, received an intravenous infusion of dexmedetomidine 0.75 mcg/kg or placebo respectively, over 15 minutes before anticipated time of end of surgery, in a double blind manner. Anesthesia techniques were standardized. Heart rate, systolic, diastolic, mean arterial pressures were recorded while starting injection, at 1, 3, 5, 10, 15 minutes after starting injection, during extubation, at 1, 3, 5 minutes after extubation, and thereafter every 5 minutes for 30 minutes. Quality of extubation was evaluated on a 5 point scale and postoperative sedation on a 6 point scale. Any event of laryngospasm, bronchospasm, desaturation, respiratory depression, vomiting, hypotension, undue sedation was noted. RESULTS: Heart rate, systolic, diastolic, mean arterial pressures were significantly higher in group B (P < 0.05). Extubation quality score of majority of patients was 2 in group A and 3 in group B. Sedation score of most patients was 3 in group A and 2 in group B. Bradycardia and hypotension incidences were higher in group A. One patient in group A, two patients in group B had vomiting. No patient had any other side effects. CONCLUSION: Dexmedetomidine 0.75 mcg/kg administered 15 minutes before extubation, stabilizes hemodynamics and facilitates smooth extubation.