Propofol
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Anaphylaxis: case report A 26-year-old woman developed anaphylaxis during treatment with propofol for general anaesthesia. The woman had a history of endometriosis and ovarian cyst. Therefore, she was planned for robotic cystectomy under general anaesthesia. She was administered pre-induction medications including glycopyrrolate and midazolam before half an hour of arriving into the operation theatre. In the operation theatre, her baseline readings of vitals were noted. Then she was injected general anaesthetic agents including IV propofol 120mg, fentanyl [fentanyl citrate] and lidocaine [lignocaine] 2% along with 100% oxygen and sevoflurane 3%. After losing consciousness, she was put on ventilation after 3 minutes of injecting vecuronium bromide. However, within 10 minutes of induction, her BP dropped to 78/34mm Hg and HR increased to 140 /min. The anaesthetic agent was suspected as a cause of this adverse event. The woman stopped receiving anaesthetic medication and mephentermine was administered. After 3 minutes, her BP was 64/32mm Hg and HR was 166 /min. Further, she started to develop angioedema, facial flushing and urticaria over forearms. Based on these findings, a diagnosis was confirmed as anaphylaxis. Hence, immediate resuscitation was done with epinephrine [adrenaline] along with fluid rush. She was also treated with hydrocortisone, dexamethasone, chlorpheniramine maleate and norepinephrine [noradrenaline]. Within 20 minutes, her vital signs recovered with BP and pulse rate of 110/66mm Hg and 90 /min, respectively. But, urticaria, facial flushing and angioedema persisted. She was then shifted to ICU for further treatment. Within 24 hours of ventilators support and steroids treatment, urticaria, oedema and flushing subsequently subsided. A blood test showed a tryptase level of 15.6, which confirmed anaphylactic reaction. Intradermal sensitivity test and patch test were found negative for all the drugs administered in the perioperative period except propofol. Therefore, propofol was suspected to be the causative agent. After undergoing a leak test, she was extubated and kept under observation. The operation was also postponed. She was kept under observation for 24 hours and discharged after 48 hours post event. The causality assessment of anaphylaxis was considered probable according to WHO-UMC and Naranjo causality scales. As per Hartwig’s severity assessment scale, the severity of anaphylaxis was considered severe (level 5). As per Modified Shummock and Thornton scale, preventability establishment revealed it as a non-preventable ADR. Saini B, et al. Propofol induced anaphylaxis, a rare anaesthetic emergency: A case report. International Journal of Pharmaceutical Sciences Review and Research 64: 194-196, 803514851 No. 1, 2020. Available from: URL: http://doi.org/10.47583/ijpsrr.2020.v64i01.035
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Reactions 14 Nov 2020 No. 1830
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