Korean J Anesthesiol.  2001 Dec;41(6):788-791. 10.4097/kjae.2001.41.6.788.

Anesthetic Considerations in Stevens-Johnson Syndrome with Status Asthmaticus

• In JH
• kim DW
• Joo JD
• Chun YS

• KMID: 2091649
• DOI: http://doi.org/10.4097/kjae.2001.41.6.788

Abstract

Stevens-Johnson syndrome is considered to be a severe type of erythema exsudativum multiforme. It is characterized by erythema with vesicobullous and eroded lesions of skin and mucous membranes. The importance in anesthetic management of Stevens-Johnson syndrome is preventing injury of the oropharyngeal and tracheal membrane at intubation because soft oral airways may cause bleeding and push tissue debris into the pharynx and larynx. In addition, anesthesiologist should take care of complications such as transitory atrial fibrillation, interstitial myocarditis, pericarditis, pneumothrax, acute renal insufficiency and conjunctivitis. A 5-year-old male, previously diagnosed with Stevens-Johnson syndrome and treated with a steroid, was noted as having dyspnea on rest, coughing, jaundice, and fever. Even after aggressive medical management for status asthmaticus during the preoperative period, dyspnea and expiratory wheezing did not improve. He underwent a resection of the gall bladder, lung and liver biopsy in spite of a great risk of perioperative pulmonary complications. After treatment with epinephrine, and aminophylline, the peak inspiratory pressure was 40 cmH2O with mild hypercarbia (PaCO2 45 50 mmHg). We report the anesthetic considerations for a case of Steven-Johnson syndrome with status asthmaticus.

Keyword

Disease: Stevens-Johnson syndrome; Lung: asthma

MeSH Terms

Acute Kidney Injury
Aminophylline
Atrial Fibrillation
Biopsy
Child, Preschool
Conjunctivitis
Cough
Cytochrome P-450 CYP1A1
Dyspnea
Epinephrine
Erythema
Fever
Hemorrhage
Humans
Intubation
Jaundice
Larynx
Liver
Lung
Male
Membranes
Mucous Membrane
Myocarditis
Pericarditis
Pharynx
Preoperative Period
Respiratory Sounds
Skin
Status Asthmaticus*
Stevens-Johnson Syndrome*
Urinary Bladder
Aminophylline
Cytochrome P-450 CYP1A1
Epinephrine