Atracurium besilate
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Anaphylactic shock: case report A 19-year-old woman developed anaphylactic shock following administration of atracurium besilate for anaesthesia and as muscle relaxant. The woman was scheduled for laparotomy surgery because of an infected left ovarian cyst. Orotracheal tube was inserted for general anaesthesia. Prior to surgery, she received various concurrent medications. She exhibited stable haemodynamic conditions. To facilitate intubation, IV atracurium besilate [atracurium] 25mg was administered. Multiple other concomitant medications were also administered. One minute following administration of atracurium besilate, hypersecretion in her airway was noticed. Subsequently, wheezing sounds were noted, and difficulty to ventilate the airway was also noted. Her oxygen saturation decreased to 80% which was followed by development of marked erythema in most parts of her skin, tachycardia (heart rate: 134–138 bpm) and hypotension (BP 67/33mm Hg). Based on the clinical presentation, a diagnosis of anaphylactic shock secondary to atracurium besilate was made. The woman was intubated immediately to maintain the airway-positive pressure ventilation with 100% fraction of inspired oxygen. She was treated with epinephrine and dexamethasone. After 1 hour, all her parameters improved. Her surgery was cancelled. Blood sample showed increased IgE. She was extubated and sent to ICU for 24h of observation as she regained consciousness. She was then moved to the inpatient ward. On day 4 after the event, she was discharged following recovery. Four weeks after the event, she was rescheduled for surgery at which time vecuronium bromide [vecuronium] was used as an alternative muscle relaxant. She underwent an uneventful surgery. Ryalino C, et al. Anaphylactic shock due to atracurium in a patient underwent general anesthesia. Open Access Macedonian Journal of Medical Sciences 8: 60-62, 2020. 803515863 Available from: URL: http://doi.org/10.3889/oamjms.2020.3774
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Reactions 21 Nov 2020 No. 1831
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