Sulphan blue
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Anaphylaxis: case report A 31-year-old woman with ductal breast cancer experienced anaphylaxis after receiving sulphan blue in order to facilitate a sentinel lymph node biopsy (SLNB). Three hours prior to undergoing the SLNB, the woman received radioactively labelled Tc 99m albumin. Anaesthesia was then induced using alfentanil, morphine and propofol, and was maintained with nitrous oxide in oxygen, and sevoflurane. After induction she was administered ondansetron, dexamethasone and amoxicillin/clavulanic acid. She also received a peritumoural injection of 1.25% sulphan blue 4mL. Ten minutes later, she developed tachycardia and hypotension with peripheral vasoconstriction. The woman was administered epinephrine [adrenaline], but this exacerbated the tachycardia with no improvement in BP. She was commenced on a norepinephrine [noradrenaline] infusion, with colloidal solution, hydrocortisone and chlorphenamine. Over the next 10 minutes, there was a gradual improvement. The operation went ahead uneventfully. Three hours postoperatively, her total serum tryptase level was elevated (44.8 ng/mL). This subsequently normalised, supporting the diagnosis of anaphylactic shock. Skin prick and intradermal tests revealed a severe reaction to sulphan blue, and a mild reaction to ondansetron. Author comment: "Our case is an example of severe, lifethreatening anaphylactic reaction that presented without any evidence of bronchospasm, laryngospasm, and oedema or skin rash. The reaction was only characterised by severe and prolonged hypotension and tachycardia refractory to adrenaline injection." Lanitis S, et al. Atypical anaphylactic reaction to Patent Blue during sentinel lymph node biopsy for breast cancer. Annals of the Royal College of Surgeons of 801117015 England 90: 338-339, No. 4, May 2008 - England
0114-9954/10/1211-0001/$14.95 Adis © 2010 Springer International Publishing AG. All rights reserved
Reactions 19 Jul 2008 No. 1211
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