Anaphylactic shock caused by an intradermal skin test-negative antibiotic during general anesthesia -A case report-

Kim, Kyu Nam; Kim, Dong Won; Sin, Yeong Hun; Oh, Song Yee

doi:10.17085/apm.2016.11.3.260

Cited by 3 publications

(3 citation statements)

References 13 publications

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“…However, since there are various medications and many supplies that come in contact with one another from the induction of anesthesia to the operation, it is difficult to distinguish the cause from the anesthetized patient because you cannot know exactly when the symptoms began. 12 The first symptom found in this case was a shock which started with tachycardia and hypotension, and the dermatological symptoms were not recognized because of the surgical drapes and abnormal respiratory symptoms were not observed. Therefore, we believe these non-specific symp-toms were not diagnosed early as anaphylaxis, but they were misdiagnosed and treated as LAST.…”

Section: Discussionmentioning

confidence: 75%

“…However, because of the low sensitivity and low positive predictive value of cephalosporin antibiotics, even if the skin test is negative, the risk of anaphylaxis cannot be completely ruled out. 1,12,20 Along with the symptoms, laboratory tests help formulate the diagnosis, and when there is an anaphylactic event, immediate examinations of serum tryptase, plasma histamine, and 24-hour urinary histamine metabolites are known to be useful.1 Among these, elevated levels of serum tryptase are the most useful biomarker to determine Ig-E-mediated hypersensitivity, reaching the maximum elevated level around 15-60 mi-nutes after anaphylaxis and lasting for 4 hours.…”

Section: Discussionmentioning

confidence: 99%

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Hypersensitivity Reaction to Perioperative Drug Mistaken for Local Anesthetic Systemic Toxicity in a Patient under Brachial Plexus Block

Jun

Kim

2018

KMJ

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Perioperative hypersensitivity is a clinical symptom associated with several mechanisms, including IgE and non-IgE mediated mechanisms, with various reports detailing minor symptoms such as skin rash to severe signs and symptoms of anaphylaxis including angioedema, bronchospasm, hypotension, tachycardia, and sudden failures of cardiopulmonary functions. 1 Reports of perioperative anaphylaxis vary in the literature and differ ac-cording to country, ranging from approximately 1:2,000-1:20,000, and is associated with actual perioperative-related morbidity and mortality, with a high mortality rate of up to 9%. 2 The various drugs used in perioperative, the inability to communicate with sedated and anesthetized patients, and the body of the patient covered with a surgical drapes are considered to be factors that hinder early recognition of anaphylactic reactions.Perioperative anaphylaxis, although rare, is a severe, life-threatening unexpected systemic hypersensitivity reaction. Simultaneous administration of various drugs during anesthesia, the difficulty of communicate with patients in sedation and anesthesia, and coverage of the patient with surgical drapes are considered to be factors that impede early recognition of anaphylactic reactions. It is very important to perform an intradermal skin test because antibiotics are the most common cause of perioperative anaphylaxis. We report a case of negative-intradermal skin test antibiotic anaphylaxis mistaken for local aesthetic systemic toxicity without increase of serum tryptase for confirmative diagnostic biomaker during surgery under brachial plexus block. It is not possible to exclude the danger of anaphylaxis completely, even if it is negative-intradermal skin test and normal tryptase level. Therefore, anesthesiologists should be closely monitored and treated early for antibiotics related hypersensitive reaction, like other medicines during anesthesia.

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Section: Discussionmentioning

confidence: 75%

Section: Discussionmentioning

confidence: 99%

Hypersensitivity Reaction to Perioperative Drug Mistaken for Local Anesthetic Systemic Toxicity in a Patient under Brachial Plexus Block

Jun

Kim

2018

KMJ

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“…Kas gevşeticiler için deri testlerinin tahmini duyarlılığı yaklaşık %94-97'dir, ancak barbitüratlar, opioidler ve benzodiazepinler için duyarlılığı zayıftır. Lateks duyarlılığı da deri testleri ile araştırılmalıdır (37) . Ancak ülkemizde yapılan bir çalışmada, lateks spesifik IgE ile belirlenen %6.6 duyarlılığa rağmen, ameliyat sırasında herhangi bir allerjik reaksiyon olmadığı için rutin preoperatif lateks allerjisi testlerinin gerekli olmadığı sonucuna varılmıştır (38) .…”

Section: Kimler Risk Altındadır?unclassified

Perioperative anaphylaxis

Ünal¹

2018

IKSST

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ÖZPerioperatif anafilaksi, operasyon sırasında meydana gelen yaşamsal tehlike oluşturan sistemik allerjik reaksiyondur. Nadir görülmesine rağmen, çoğunlukla ciddi seyretmektedir. Perioperatif anafilaksi nedenleri nöromüsküler bloke edici ajanlar (NMBA), antibiyotikler, lateks, hipnotik indüksiyon ajanları (başta barbitüratlar), klorheksidin, opioidler ve kolloidlerdir. Perioperatif anafilaksi için risk faktörleri arasında kadın cinsiyeti (belirli ilaçlar için), mast hücre bozuklukları, diğer alerjik durumlar (astım, egzema veya saman nezlesi gibi), çoklu ameliyat öyküsü (özellikle lateks ve etilen oksit için) ilaç allerjisi ve atopi vardır.Akut astım atağı, aspirasyon, endotrakeal tüp malpozisyonu, malign hipertemi, pulmoner ödem, pulmoner tromboemboli, tansiyon pnömotoraks, transfüzyona bağlı akut akciğer hasarı, aritmiler, kardiyak tamponad, kardiyojenik şok, kanama, hiperkalemi kliniği perioperatif anafilaksinin ayırt edici tanılarını oluşturmaktadır. ABSTRACTPerioperative anaphylaxis is a life-threatening systemic allergic reaction that occurs during the operation. Although it is seen rarely, mostly it leads a serious course. The causes of perioperative anaphylaxis include use of neuromuscular blocking agents (NMBA), antibiotics, latex, hypnotic induction agents (mainly barbiturates), chlorhexidine, opioids and colloids. Risk factors for perioperative anaphylaxis are as follows: female gender (for certain drugs), mast cell disorders, other allergic conditions (such as asthma, eczema or allergic rhinitis), multiple surgical history, drug allergy and atopy (especially for latex and ethylene oxide).Acute asthma attack, aspiration, endotracheal tube malposition, malignant hyperthermia, pulmonary edema, pulmonary thromboembolism, tension pneumothorax, transfusion dependent acute lung injury, arrhythmias, cardiac tamponade, cardiogenic shock, hemorrhage, hyperkalaemia should be also considered in the differential diagnosis of perioperative anaphylaxis.

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Anaphylaxis occurred immediately after prophylactic antibiotics injection with negative intradermal skin test during laparoscopic cholecystectomy

Jeong

Kung

Park

et al. 2018

KMJ

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Prophylactic antibiotics that are used to prevent post-operative infection can commonly cause anaphylactic reactions during anesthesia. It is therefore necessary to perform a skin test before antibiotics are administered in order to diagnose and prevent anaphylactic reactions. However, the results of the antibiotic skin test can differ according to the drug, dose, and reagent concentration. We report a case of anaphylactic shock with bronchospasm and cardiovascular collapse immediately following administration of the prophylactic cefazedone after induction of general anesthesia for laparoscopic cholecystectomy.

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Anaphylactic shock caused by an intradermal skin test-negative antibiotic during general anesthesia -A case report-

Cited by 3 publications

References 13 publications

Hypersensitivity Reaction to Perioperative Drug Mistaken for Local Anesthetic Systemic Toxicity in a Patient under Brachial Plexus Block

Hypersensitivity Reaction to Perioperative Drug Mistaken for Local Anesthetic Systemic Toxicity in a Patient under Brachial Plexus Block

Perioperative anaphylaxis

Anaphylaxis occurred immediately after prophylactic antibiotics injection with negative intradermal skin test during laparoscopic cholecystectomy

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