TOXIC EPIDERMAL NECROLYSIS AND ITS ASSOCIATION WITH LOCAL ANESTHESIA

Abstract

Toxic epidermal necrolysis (TEN), also known as Lyell Syndrome, is a rare and serious skin reaction characterized by extensive necrosis and detachment of the epidermis. This condition is often triggered by adverse reactions to medications, and is widely recognized for its severity and high mortality rate. The association of TEN with the administration of local anesthesia represents a topic of clinical interest, as TEN can manifest in response to exposure to a variety of substances, including anesthetic medications. Objective: to investigate the association between toxic epidermal necrolysis and the administration of local anesthesia, examining risk factors, signs and symptoms, prevention strategies and treatments used. Methodology: This systematic literature review followed the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. The search for articles was carried out in the PubMed, Scielo and Web of Science databases, covering a period of 10 years (2013-2023). Five main descriptors were used for the research: "toxic epidermal necrolysis", "Lyell Syndrome", "local anesthesia", "adverse drug reactions" and "surgical complications". The inclusion criteria for the studies considered the relevance of the topic, studies published in the last 10 years, and direct or indirect relationships between TEN and the administration of local anesthesia. Exclusion criteria included duplicate studies, studies without access to the full text, and those that did not address the association between TEN and local anesthesia. Results: 15 works were selected. Key topics included risk factors such as individual sensitivity to certain local anesthetics, signs and symptoms that may indicate the development of TEN following administration of local anesthesia, prevention strategies such as careful use of anesthetics and post-operative monitoring, and treatments adopted, which often involved immediate interruption of the triggering agent and supportive care. Conclusion: This systematic literature review highlighted the importance of recognizing the association between toxic epidermal necrolysis and the administration of local anesthesia, highlighting the need for preventative measures and appropriate treatment strategies. Individual sensitivity to local anesthetics and the ability to identify signs of TEN early are crucial elements for preventing serious complications. Adequate postoperative monitoring and immediate discontinuation of the triggering agent are essential practices to minimize risks. In summary, the review highlights the relevance of a cautious and informed approach when it comes to the administration of local anesthesia in patients susceptible to TEN, aiming for patient safety and well-being.