1/23. Anaphylactic reactions during induction of anaesthesia using rocuronium for muscle relaxation: a report including 3 cases.anaphylaxis during induction of anaesthesia is a dreaded complication with a mortality rate of 3-6%, most frequently associated with the use of muscle relaxants. Current knowledge on this matter is reviewed in relation to the presentation of 3 cases of anaphylaxis and bronchospasm associated with the use of the recently released nondepolarizing muscle relaxant rocuronium. Bronchospasm may be the sole sign of a serious drug reaction, triggered by precipitation of insoluble thiopental crystals when mixed with a muscle relaxant in the intravenous (iv) line. It is recommended that these drugs are administered via different injection ports. The hypotension requires immediate treatment with oxygen, epinephrine and large amounts of iv fluids. epinephrine infusion may be needed for hours. It is recommended that serum tryptase is measured approximately 2 h after debut of the serious drug reaction. Allergy testing should be performed for all the drugs the patient was exposed to, 4-8 weeks after the incident, and due to cross-reactivity, including all available muscle relaxants. Doctors are urged to inform their patients, and systematically register adverse drug reactions.- - - - - - - - - - ranking = 1keywords = anaesthesia (Clic here for more details about this article) |
2/23. vancomycin reaction during spinal anaesthesia.A 77-year-old female received uneventful spinal anaesthesia for a total knee replacement. Upon the advice of the microbiologists and at the request of the orthopaedic surgeon, a vancomycin infusion was commenced prior to the application of the leg tourniquet. Five minutes later, having received only 40 mg of the antibiotic dose, she became unconscious and suffered severe cardiovascular collapse, from which she was resuscitated with intravenous ephedrine and adrenaline.- - - - - - - - - - ranking = 1keywords = anaesthesia (Clic here for more details about this article) |
3/23. An unexpected cause of an acute hypersensitivity reaction during recovery from anaesthesia.Acute hypersensitivity reactions to chlorhexidine in the operating room are probably more likely to occur during the early phases of anaesthesia because chlorhexidine is often used for cleaning the surgical field or during placement of indwelling catheters. We report a case of an acute hypersensitivity reaction that occurred in the post anaesthetic care unit. Subsequent skin testing suggested sensitivity to chlorhexidine, which had been applied over the vaginal mucosa at the end of surgery. Relevant issues in the investigation of acute hypersensitivity reactions in the post anaesthetic period are discussed.- - - - - - - - - - ranking = 1keywords = anaesthesia (Clic here for more details about this article) |
4/23. Intraoperative anaphylaxis: verba volant, scripta manent!We describe a case of intraoperative gelatine-induced anaphylaxis whose diagnosis was delayed as the use of gelatine during surgical procedures was omitted for two times in patient's medical records. The subject is a 66-year old woman, with a negative medical history of atopy, food and drug allergy, with arterial hypertension on a course of beta-blockers and with bladder carcinoma requiring surgery. The patient had tolerated both general and local anaesthesia on several previous occasions. On the first occasion she experienced arterial fibrillation secondary to a severe episode of hypotension following local anaesthesia, while on a course of beta-blockers. On the second occasion she developed a very severe episode of hypotension followed by the outbreak of a generalised rash during general anaesthesia. The tryptase sera level was 109 mg/L one hour after the reaction had subsided, while the basal values were normal. On the third occasion the patient redeveloped severe hypotension and a generalised rash during general anaesthesia. The allergological work-up was negative, except for intradermal test with gelatine. A study of the intra-cellular cytokines in blood lymphocytes showed a production of IL4 from CD4 lymphocytes after stimulation by gelatine. The patient underwent a successive surgical procedure without any adverse event.- - - - - - - - - - ranking = 0.8keywords = anaesthesia (Clic here for more details about this article) |
5/23. Perioperative anaphylaxis from locally applied rifamycin SV and latex.A patient developed severe anaphylaxis during irrigation of a wound with rifamycin SV. The temporal relationship between application of rifamycin SV, the positive skin test and basophil activation test for rifamycin SV strongly supported diagnosis of anaphylaxis from the locally applied antibiotic. However, after operation the patient had two anaphylactic reactions with pruritus, urticaria and angio-oedema after routine care by a nurse, and these were probably caused by natural rubber latex. This case report has several messages. First, it is not widely appreciated that topically applied drugs and related compounds can elicit life-threatening anaphylaxis. Second, it illustrates patients can present with more than one allergy. Finally, it provides an opportunity to summarize the applications of flow cytometry-assisted quantification of in vitro activated basophils in diagnosing the cause of anaphylaxis during anaesthesia.- - - - - - - - - - ranking = 0.2keywords = anaesthesia (Clic here for more details about this article) |
6/23. Simultaneous anaphylaxis to thiopentone and a neuromuscular blocker: a study of two cases.Two women experienced anaphylactoid reactions after induction of general anaesthesia. Prick tests, intradermal tests (IDT), human basophil degranulation tests (HBDT) and a quaternary ammonium sepharose radioimmunoassay were undertaken several weeks later and repeated together with a leucocyte histamine release (LHR) test after 4 months. anaphylaxis to suxamethonium was documented by four tests in patient 1 and to pancuronium by four tests in patient 2. anaphylaxis to thiopentone was shown with IDT, HBDT and LHR in both women. It was concluded that simultaneous anaphylaxis to thiopentone and a neuromuscular blocker had occurred in these patients.- - - - - - - - - - ranking = 0.2keywords = anaesthesia (Clic here for more details about this article) |
7/23. Cholinesterase deficiency and the churg-strauss syndrome.We report two patients with the churg-strauss syndrome who were found to have decreased cholinesterase activity despite normal phenotypes. Suspicion of abnormal sensitivity to suxamethonium in the first case was raised after prolonged paralysis under anaesthesia. The findings in the second were incidental during the course of intensive care treatment. Both patients received immunosuppressive therapy. Differentiation between the effects of this and the disease process itself cannot be established.- - - - - - - - - - ranking = 0.2keywords = anaesthesia (Clic here for more details about this article) |
8/23. Anaphylactoid reaction to alcuronium.A 67-year-old woman suffered cardiovascular collapse during induction of anaesthesia. This was later shown to be anaphylactic in origin; the causative agent was alcuronium. in vitro testing showed a highly specific sensitivity to alcuronium with minimal cross-reactivity. Future anaesthesia with decreased risk was thereby assured. The clinical nature of this reaction and a review of the literature implicate the cardiovascular system as the principal target in this type of reaction to alcuronium and suggest that the heart is directly involved.- - - - - - - - - - ranking = 0.4keywords = anaesthesia (Clic here for more details about this article) |
9/23. Basophil histamine release. A study in allergy to suxamethonium.A patient who suffered a severe hypotensive episode after induction of anaesthesia, was subsequently found to show positive skin-test responses to suxamethonium. Investigation revealed that suxamethonium induced basophils from the patient to release histamine to an extent comparable to that found after exposure to anit-IgE. basophils from control subjects showed no such response. Basophil histamine release may offer a useful approach to the investigation of adverse drug reactions.- - - - - - - - - - ranking = 0.2keywords = anaesthesia (Clic here for more details about this article) |
10/23. pancuronium allergy: a case report.A case of anaphylactic shock to pancuronium bromide is described in which a type I immunological reaction occurred. A 33-yr-old male anaesthetist, with no family or personal history of allergy, collapsed soon after induction of anaesthesia. The drugs used included fentanyl, droperidol, thiopentone and pancuronium. Diffuse erythema occurred, with probable cardiac arrest. The patient was treated with cardiac massage, sympathomimetics and cortisone, and made a complete recovery. Examination (skin tests, passive transfer according to Prausnitz and Kustner, in vitro lymphocyte transformation test, total IgE assay) revealed that the allergic reaction was to pancuronium bromide.- - - - - - - - - - ranking = 0.2keywords = anaesthesia (Clic here for more details about this article) |
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