Sulphan blue
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Anaphylaxis with heart arrest: case report A 54-year-old woman undergoing breast cancer surgery developed anaphylaxis with heart arrest during lymphatic mapping with sulphan blue. The woman, whose medical history included breast cancer, hypertension and excess body weight, was scheduled for wide local excision and sentinel lymph node biopsy. She was induced with anaesthesia and, after induction, subcutaneous sulphan blue [Guerbet] 2.5% was injected close to the tumour site. Three hours after the injection, she collapsed suddenly with pulseless electrical activity whilst the surgeons were closing. The woman successfully underwent advanced cardiopulmonary resuscitation. Subsequently, hypotension recurred and she developed acute hypoxaemia. Thoracic CT revealed a diffuse pulmonary oedema and echocardiography showed mild global systolic dysfunction. Her shock was attributed to anaphylaxis. Histamine receptor antagonists and corticosteroids were initiated. Haemodynamic and respiratory instability necessitated the use of vasopressor therapy, mechanical ventilation and oxygenotherapy. As a result of oliguric renal failure, severe metabolic acidosis developed. She also developed acute disseminated intravascular coagulation and thrombocytopenia. On postoperative day 4, she underwent surgery to drain a breast haematoma for which she received general anaesthesia without the previously administered anaesthetic drugs. Following this, her respiratory and cardiovascular functions improved progressively; her tracheal tube was removed on postoperative day 5. The next days were uneventful and, on postoperative day 8, she was discharged from the ICU. She was discharged from hospital on postoperative day 15. She underwent complete allergic investigations with skin prick and intradermal tests to potential allergans that were given during surgery, 6 weeks after the anaphylactic event, but sulphan blue was not administered due to the risk of a possible life-threatening adverse reaction. All other tested intraoperative potential allergens were negative; these included propofol, latex, sufentanil, cefazolin and vecuronium bromide. Author comment: "This report describes the case of a severe anaphylactic reaction to [sulphan blue] with a very unusual clinical presentation." Thierrin L, et al. Severe anaphylactic shock to Patent Blue V with cardiac arrest during breast carcinoma surgery with lymphatic mapping. European Journal of Obstetrics and Gynecology and Reproductive Biology 140: 140-141, No. 1, Sep 801124619 2008 - Switzerland
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Reactions 15 Nov 2008 No. 1228
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