Anesthesia in a patient with multiple allergies

Kulkarni, Saurabh; Kelkar, Vasanti; Nayak, Prabha P

doi:10.4103/0970-9185.137291

Cited by 4 publications

(4 citation statements)

References 4 publications

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“…Notably, mefenamic acid also acts as an anti-inflammatory. Kulkarni SJ et al also reported a case of allergy to paracetamol and diclofenac and not to ibuprofen [ 11 ]. Our testing also showed the same.…”

Section: Discussionmentioning

confidence: 99%

“…Hypersensitivity and allergic reactions to NSAIDs are reported in the literature. However, an allergy to multiple regularly used drugs in a single patient is rare [ 11 ]. Further, cross-sensitivity or allergy to other related medications, i.e., mefenamic, naproxen, and acetaminophen cross-sensitivity; penicillin and first-generation cephalosporin cross-allergy, is another possibility that needs to be considered while managing such cases.…”

Section: Introductionmentioning

confidence: 99%

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Perioperative Management Conundrum for a Case With Multiple Commonly Used Drug Hypersensitivity

Bansal,

Karim,

Rai

et al. 2024

Cureus

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Perioperative hypersensitivity reactions vary from mild to potentially fatal anaphylaxis, resulting in significant morbidity and mortality. Most of the perioperative hypersensitivity and allergic reactions are attributed to antibiotics, antiseptic solutions, latex, and opioids. In the current thrust for opioid-free anesthesia, owing to its multiple advantages, paracetamol and nonsteroidal antiinflammatory agents play a significant role in multi-modal pain and inflammatory response management. Nearly nine out of ten individuals experience postoperative pain, one-third experience postoperative nausea and vomiting, and one-fourth experience fever, irrespective of surgery and type of anesthesia, often as an inflammatory response. While perioperative hypersensitivity reactions are common, a patient allergic to multiple commonly used drugs for the treatment of pain, fever, acid-peptic disorder, and nausea and vomiting is scarce. Such cases pose a great challenge in perioperative management. A 14-year-old male child with a traumatic foot drop planned for tibialis posterior tendon transfer developed an allergic reaction with mild fever following an injection of Ranitidine and Ondansetron in the preoperative area. Surgery was deferred and was investigated for allergy profile testing for commonly used drugs, which showed high IgE levels and moderate to severe hypersensitivity for diclofenac and paracetamol. The patient was operated on after one month under spinal anesthesia, avoiding ranitidine, ondansetron, diclofenac, and paracetamol. The following morning, he developed a high-grade fever (102.3° F), which did not resolve with conservative measures. Hypersensitivity and allergic reactions to NSAIDs are reported in the literature. While there are multiple drugs available as NSAIDs, cross-sensitivity or allergy to other drugs within the same group, and even chemically related groups, is also another possibility that needs to be considered while managing such patients. Mefenamic acid controlled the fever, and the child was discharged home after 48 hours of observation. However, the case posed a great perioperative management dilemma; the present report intends to highlight and discuss it.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Perioperative Management Conundrum for a Case With Multiple Commonly Used Drug Hypersensitivity

Bansal,

Karim,

Rai

et al. 2024

Cureus

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“…A literature search yielded a limited number of related case reports [ 6 ]. It is recommended that anaesthesia for patients is only attempted after delineating an accurate cause of anaphylaxis and/or a potentially severe life threatening immunologic reaction.…”

Section: Discussionmentioning

confidence: 99%

Anaesthesia for a biopsy of corpus callosum in patient with a recent intra-operative anaphylaxis to an unknown anaesthetic allergen: a case report

Licina¹

2018

BMC Anesthesiol

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BackgroundAnaphylaxis in general anaesthesia occurs with a frequency of 1:5000-1:20000. This clinical summary reports on the use of an effective risk management strategy employing second line anaesthesia agents and alternative endotracheal intubation tools in a patient with a recent history of an intra-operative anaphylaxis to an unknown anaesthetic agent.Case presentationA 71-year-old male presented for a repeat biopsy of corpus callosum 4 days following the cancellation of the procedure for a presumed anaphylactic reaction to an unknown anaesthetic agent.During the repeat care episode, the decision was made to proceed based on the urgent need for tissue diagnosis to facilitate further treatment and lack of feasibility for more definitive identification of the causative agent(s). A consideration was made of the optimum ways to manage and mitigate risk in this setting.The airway was managed using flexible endoscopic intubation in a spontaneously ventilating awake patient. Continuous remifentanil infusion was maintained throughout the case. Anaesthesia was maintained with sevoflurane at less than one MAC, with an uneventful completion of the biopsy of corpus callosum. All of the anaesthetic agents used during the prior care episode, with the exception of remifentanil, were avoided.ConclusionIn cases of an anaphylaxis to an unknown anaesthetic allergen, anaesthetic strategy consists of careful risk mitigation and deployment of second agent approaches. Awake flexible endoscopic intubation and remifentanil infusion are viable alternatives to standard induction techniques.

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“…[2] Inhalational anesthesia is considered safe in patients with multiple drug allergies, as there have been no reports of anaphylaxis to volatile inhalational agents. [3456]…”

Section: Introductionmentioning

confidence: 99%

Safety of inhalational anesthesia in patients with multiple drug allergies presenting for major surgeries under general anesthesia

et al. 2019

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The prevalence of perioperative anaphylaxis is 1 in 1250–20,000 anesthetics. Inhalational anesthesia is considered safe in patients with multiple drug allergies, as there have been no reports of anaphylaxis to volatile inhalational agents. Anesthetic management of six patients with documented allergy to all commonly used anesthetic drugs who underwent major surgeries under general anesthesia is described as a case series. The plan of anesthesia in these patients was an anesthetic gas-based general anesthesia without using muscle relaxants but with the use of intravenous fentanyl if patient was not allergic to it. Sevoflurane 8% in oxygen was used for induction. Following cessation of breathing and on attaining an end-tidal concentration of >4% sevoflurane, direct laryngoscopy and intubation were performed. Anesthesia was maintained with sevoflurane in nitrous oxide and oxygen mixture maintaining a lower end-tidal carbon dioxide. Hypotension and/or bradycardia were managed with intermittent intravenous boluses of adrenaline 20 μg. At the end of surgery, all anesthetic gases were cutoff, and patients were extubated when awake. No muscle relaxant was used in any of the cases. Two patients received fentanyl before induction, whereas others were given oral paracetamol 2 h before induction. Postoperative analgesia was provided with oral paracetamol which was given 2–4 h after surgery. Intraoperative period was uneventful for these patients. In patients with multiple drug allergies, inhalational agent-based general anesthesia can be considered as a safe alternative to regular anesthetic practice involving polypharmacy, with a reduced risk of perioperative adverse events.

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Anesthesia in a patient with multiple allergies

Cited by 4 publications

References 4 publications

Perioperative Management Conundrum for a Case With Multiple Commonly Used Drug Hypersensitivity

Perioperative Management Conundrum for a Case With Multiple Commonly Used Drug Hypersensitivity

Anaesthesia for a biopsy of corpus callosum in patient with a recent intra-operative anaphylaxis to an unknown anaesthetic allergen: a case report

Safety of inhalational anesthesia in patients with multiple drug allergies presenting for major surgeries under general anesthesia

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