Allergy to anaesthetic agent
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Transcript of Allergy to anaesthetic agent
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Helga Komen Ušljebrka, MD, anaesthesiologist Department of Anaesthesiology and Intensive
CareUniversity Hospital Rijeka, Croatia
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Patient historyM.P., female, 67 yearsBMI 27.3 kg/m2
Dg: CholelithiasisElective surgery: Laparoscopic
cholecystectomy
Comorbidity: Hypotireosis, Hypertension, Hyperlipoproteinemy
Th: levothyroxine 25 μg, cilazapril 2.5 mgNo previous operations (general or regional
anaesthesia)Allergy to anaesthetic agent
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Preoperative physical examination: Respiratory status NAHemodinamical status:
BP 140/85 mmHg ECG - axis 15o , sinus rhytm 78/min
Laboratory findings: Thyroid hormons – T3 2.11 nmol/L, T4 170.62
nmol/L, TSH 1.65 mIU/L (within range) Full blood count , biochemical analysis – NA
Allergies: ǾAllergy to anaesthetic agent
Patient history
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enoxaparin 40 mg sc, 21.00h evening before surgery
midazolam 7.5 mg orally, 1 h preoperatively (9.30 AM)
BP 155/85 mmHgHR 90/min
Allergy to anaesthetic agent
Preoperatively...
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Standard monitoring – ECG, SpO2, NIBPiv line 18 G, left hand
Induction of anaesthesia (10.40 AM): sufentanil 30 μg ivthiopental 350 mg ivrocuronium 40 mg iv → Rash
→ Orotracheal intubation (10.43 AM)
Allergy to anaesthetic agent
Intraoperatively...
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.......deep hypotension – 45/20 mmHg
.......difficult ventilation – peak airway pressure 32 cmH20, SpO2 91 %, FiO2 100%
→ Asistoly→ CPR according to ALS algorythm
+ fluid resuscitation, antihistaminic, steroid
After 45 minutes....ROSC!
Allergy to anaesthetic agent
Intraoperatively...
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• Cancelled surgery → ICU admission
• Vasoactive drugs – excluded POD 2Respiratory support – weaning and extubation POD 9
POD 1, MSCT of the brain: normal findingPOD 3, MSCT of the brain: ischemia cortically and
subcortically in the right hemisphereNeurological status (POD 7): left hemiplegia with
tendency of recovery......
Discharge POD 19 – paresis of left hand, patient in contact
Allergy to anaesthetic agent
ICU
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Allergy testing (3 months later)
Skin test
midazolam, propofol, thiopental, sufentanil, soya – NEGATIVE
Rocuornium - POSITIVE
Allergy to anaesthetic agent
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Questions to be answered!Incidence of allergy to muscle
relaxants/anaesthetics?How to predict it?In case of, what is the alternative?
Allergy to anaesthetic agent
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Statistics....Anaphylaxis in anaesthesia 1/10 000 – 1/
20 000Grade I - VPseudoanaphylaxis – chemically mediated
histamine release50% on NMBAs (leptosucyn, rocuronium)
Cross-alergy! Folcodine
Allergy on food no importantAllergy to anaesthetic agent
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THANK YOU!
Allergy to anaesthetic agent