Concurrent positive skin tests to prophylactic antibiotics and rocuronium in two patients with life-threatening anaphylaxis after induction of anesthesia.
Adrenaline (epinephrine)
Anaphylaxis
Anti-bacterial agents
General anesthesia
Neuromuscular blocking agents
Skin tests
Journal
JA clinical reports
ISSN: 2363-9024
Titre abrégé: JA Clin Rep
Pays: Germany
ID NLM: 101682121
Informations de publication
Date de publication:
20 Apr 2021
20 Apr 2021
Historique:
received:
25
03
2021
accepted:
07
04
2021
revised:
06
04
2021
entrez:
20
4
2021
pubmed:
21
4
2021
medline:
21
4
2021
Statut:
epublish
Résumé
Prophylactic antibiotics and neuromuscular blocking agents (NMBA) are two of the major causative agents of anaphylaxis after induction of anesthesia. One female and one male patients (aged 29 and 69 years, respectively) had Ring and Messmer scale grade III anaphylaxis after administration of prophylactic antibiotics following induction of anesthesia. They showed typical hemodynamic and respiratory features of life-threatening anaphylaxis. Postoperative skin tests in these two patients were positive for antibiotics and concurrently positive for rocuronium. Our present report suggests the possibility that both prophylactic antibiotics and NMBA concurrently and synergistically enhance anaphylactic reaction and the necessity to differentiate an immune mechanism from non-immune mechanisms when anesthesiologists encounter concurrent positive skin tests for both antibiotics and NMBA.
Sections du résumé
BACKGROUND
BACKGROUND
Prophylactic antibiotics and neuromuscular blocking agents (NMBA) are two of the major causative agents of anaphylaxis after induction of anesthesia.
CASE PRESENTATION
METHODS
One female and one male patients (aged 29 and 69 years, respectively) had Ring and Messmer scale grade III anaphylaxis after administration of prophylactic antibiotics following induction of anesthesia. They showed typical hemodynamic and respiratory features of life-threatening anaphylaxis. Postoperative skin tests in these two patients were positive for antibiotics and concurrently positive for rocuronium.
CONCLUSIONS
CONCLUSIONS
Our present report suggests the possibility that both prophylactic antibiotics and NMBA concurrently and synergistically enhance anaphylactic reaction and the necessity to differentiate an immune mechanism from non-immune mechanisms when anesthesiologists encounter concurrent positive skin tests for both antibiotics and NMBA.
Identifiants
pubmed: 33877516
doi: 10.1186/s40981-021-00440-0
pii: 10.1186/s40981-021-00440-0
pmc: PMC8058118
doi:
Types de publication
Journal Article
Langues
eng
Pagination
37Références
Int J Mol Sci. 2017 Jun 07;18(6):
pubmed: 28590439
Clin Infect Dis. 1994 Mar;18(3):422-7
pubmed: 8011827
Br J Anaesth. 2018 Jul;121(1):159-171
pubmed: 29935567
Clin Mol Allergy. 2018 Jul 9;16:16
pubmed: 30002605
Br J Anaesth. 2019 Jul;123(1):e50-e64
pubmed: 31130272
Anesthesiology. 2014 Aug;121(2):272-9
pubmed: 24787350
J Anesth. 2021 Feb;35(1):154-160
pubmed: 33420820
Allergol Int. 2016 Jan;65(1):52-5
pubmed: 26666489
Anesth Essays Res. 2012 Jul-Dec;6(2):115-23
pubmed: 25885603
Presse Med. 2016 Sep;45(9):758-67
pubmed: 27181074
J Allergy Clin Immunol Pract. 2018 Jul - Aug;6(4):1176-1184
pubmed: 29454709
Br J Anaesth. 2019 Jul;123(1):e117-e125
pubmed: 30915999