Sulphan blue
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Cardiac arrest and anaphylaxis: 2 case reports In a case series, a-61-year-old man and a 31-year-old woman were described, who developed anaphylaxis followed by cardiac arrest (one patient) and anaphylaxis (one patient) respectively during intraoperative lymph node mapping with sulphan blue [Patent blue; dosages and routes not stated]. Case 1: A 61-year-old man, who was diagnosed with melanoma, was admitted for sentinel lymph node mapping and excision of a right flank melanoma. He was non-atopic. At induction, he received fentanyl, cefazolin [Ancef], suxamethonium chloride [succinylcholine], propofol, topical chlorhexidine 2% and ketorolac [Toradol], followed by sulphan blue and Tc-99m-sulfur-colloid [technetium-99 Sulfur-Colloid]. Within 15 minutes of induction, he developed hypotension followed by cardiac arrest. Cardiopulmonary resuscitation was therefore initiated along with epinephrine infusion which led to return of spontaneous circulation. A skin test of sulphan blue for both 1:10 and full-strength dilutions was positive. Based on above-mentioned results, he was diagnosed with anaphylaxis and cardiac arrest secondary to sulphan blue. Subsequently, he successfully underwent surgery without the use of sulphan blue. Case 2: A 31-year-old woman, who was diagnosed with cervical squamous cell carcinoma, was admitted for radical hysterectomy and sentinel lymph node dissection. During induction, she received cefazolin [Ancef], fentanyl, propofol, suxamethonium chloride [succinylcholine], topical chlorhexidine 2%, followed by injection of Tc-99m-sulfur-colloid [technetium-99 Sulfur-Colloid] and sulphan blue. Shortly after the injection of Tc-99m-sulfur-colloid and sulphan blue, she developed urticaria and angioedema and became severely hypotensive [time to reaction onset not stated]. She therefore required resuscitation with vasopressors, and the surgery was aborted. A skin test of sulphan blue for both 1:10 and full-strength dilutions was positive. Based on above-mentioned results, she was diagnosed with anaphylaxis secondary to sulphan blue. Thus, she successfully underwent repeat surgery without the use of sulphan blue. Almasri W, et al. Severe perioperative anaphylaxis caused by Patent Blue Dye injection for sentinel lymph node mapping: A report of two cases. Allergy, Asthma and Clinical 803515298 Immunology 16 (Suppl. 1): 2020. Available from: URL: http://doi.org/10.1186/s13223-020-00445-x [abstract]
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Reactions 14 Nov 2020 No. 1830
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