Anesthetic management of toxic epidermal necrolysis: a report of two cases

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.Copyright © 2023 Faculty of Anaesthesia, Pain and Intensive Care, AFMS. All rights reserved.

Medical faculty students risk perception, attitudes, and behaviors regarding protection from COVID-19 infection.

OBJECTIVE: This study aims to determine the risk perception, attitude, and behavior characteristics of Pamukkale University Faculty of Medicine students towards protection from COVID-19. SUBJECTS AND METHODS: A total of 698 (48.2%) students of Pamukkale University Faculty of Medicine participated in this analytical cross-sectional study. Dependent variables were attitudes and behaviors related to protection from COVID-19, and independent variables were socio-demographic characteristics, sources of information about COVID-19, and health status. Data was collected through a survey using Google Forms. SPSS 17.0 (Inc., Chicago, IL, USA) software package was used for statistical analysis. Descriptive statistics were expressed as numbers and percentages for nominal data and mean and standard deviation for numerical data. Numerical data were compared with Mann Whitney U and Kruskal Wallis tests. Spearman correlation and backward linear regression analyses were used. A p-value of <0.05 was considered significant. RESULTS: The mean age of 698 students participating in the study was 21.8±2.2, and 60% of them were female. The mean attitude score was 54.99±5.17 and the mean behavior score was 50.64±6.06. The information sources of the students about COVID-19 were TV news (69.3%). Linear regression analysis revealed that attitude scores of the female gender were higher than male gender (ß=0.757±0.364 p=0.038, 95% CI: 0.440-1.471) and scores for using websites/social media accounts of professional organizations and professional associations as information sources were higher than not using (ß=0.981 ± 0.388 p=0.011 95% CI: 0.230-1.732). CONCLUSIONS: Medical students' attitude and behavior score towards protection against COVID-19 infection is slightly above the average level. Medical education should prepare students to manage epidemics.

Effects of the Beach Chair Position on Respiratory Function in Covid-19 Patients

Introduction: Whether beach chair position can improve pulmonary compliance in mechanically ventilated subjects with Coronavirus disease 2019 (COVID-19) is unclear. This study aimed to investigate the impact of beach chair position on pulmonary compliance and oxygenation in mechanically ventilated patients with COVID-19. Material(s) and Method(s): Forty-four COVID-19 subjects admitted to intensive care unit (ICU) of our institute who receive invasive mechanical ventilation were enrolled in this observational study. Patients were initially placed in supine position. Following a couple of hours patients were then placed in beach-chair position (head of bed elevated to 30 degrees) at least 16 hours a day. Data from mechanical ventilator was recorded hourly in each position. Total compliance was defined as tidal volume (VT, milliliters) divided by the difference between plateau pressure (cm H2O) and positive end-expiratory pressure (PEEP, cm H2O) Blood gas analysis was performed bi-hourly. Mean values were taken for statistical analysis. The difference in lung compliance, airway resistance, and blood gas analysis between supine and beach chair position was the primary outcome measure of this study. Result(s): Positioning patients form supine to beach-chair led to a significant improvement in lung compliance (29.68+/-10.42 ml/cm H2O vs. 33.96+/-11.71 ml/cm H2O, p<0.001), reduction in airway resistance (17.51+/-8.44 H2O/L/sc vs. 16.73+/-8.06 H2O/L/sc, p<0.001) and led to a significant decline in plateau pressure (30.82+/-5.94 cm H2O vs. 29.98+/-5.68 cm H2O, p=0.001). Moreover a significant improvement in PaO2 was observed following positioning from supine to beach-chair (67.93+/-20.29 mm Hg vs. 87.83+/-27.33 mm Hg, p<0.001). Conclusion(s): Compared to supine position, beach chair positioning improves lung compliance and oxygenation in COVID-19 patients with acute respiratory distress syndrome (ARDS) who receive invasive mechanical ventilation. Copyright © 2022 A. CARBONE Editore. All rights reserved.

The Relationship between State-Trait Anxiety Levels, Hopelessness Levels and Duration of Hospitalization in Patients with Covid-19

Objective: In addition to its physical effects, COVID-19 also causes significant psychological effects. Our study aimed to investigate the relationship between state and trait anxiety and hopelessness levels of inpatients with sociodemographic variables and length of hospital stay. Methods: 161 patients hospitalized with the diagnosis of COVID-19 who received in-hospital treatment between 20.11.2020-10.01.2021 in hospital were included in the study. After the interview with the patients, the Sociodemographic data form, State-Trait Anxiety Scale and Beck Hopelessness Scale (BHS) were administered online via Google Forms. Results: A significant correlation was detected between participants' Trait Anxiety Scale scores and State Anxiety Scale scores (r: 0.436;p<0.001). But, no correlation was detected between participants' BHS total scores and State Anxiety Scale scores (r: -0.080, p=0.314). Anxiety scores of patients hospitalized for more than 3 days increased significantly (p=0.010). None of the features such as age, gender, educational status, history of psychiatric disease caused a difference in anxiety and hopelessness levels. Conclusion: COVID-19 patients had lower anxiety levels in the first 3 days after hospitalization, it was observed that their anxiety levels increased as the duration of hospitalization was prolonged. Accordingly, psychosocial interventions should be planned for people with prolonged hospitalization.