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Allergy to anaesthetic agent
Allergy to anaesthetic agent
Allergy to anaesthetic agent
Allergy to anaesthetic agent
Allergy to anaesthetic agent
Allergy to anaesthetic agent
Allergy to anaesthetic agent
Allergy to anaesthetic agent
Allergy to anaesthetic agent
Allergy to anaesthetic agent
Allergy to anaesthetic agent
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Allergy to anaesthetic agent

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  • 1. Helga Komen Ušljebrka, MD, anaesthesiologistDepartment of Anaesthesiology and Intensive Care University Hospital Rijeka, Croatia
  • 2. Patient historyM.P., female, 67 years BMI 27.3 kg/m2Dg: CholelithiasisElective surgery: Laparoscopic cholecystectomyComorbidity: Hypotireosis, Hypertension, HyperlipoproteinemyTh: levothyroxine 25 μg, cilazapril 2.5 mgNo previous operations (general or regional anaesthesia) Allergy to anaesthetic agent
  • 3. Patient historyPreoperative physical examination: Respiratory status NA Hemodinamical status:  BP 140/85 mmHg  ECG - axis 15o , sinus rhytm 78/min Laboratory findings:  Thyroid hormons – T3 2.11 nmol/L, T4 170.62 nmol/L, TSH 1.65 mIU/L (within range)  Full blood count , biochemical analysis – NAAllergies: Ǿ Allergy to anaesthetic agent
  • 4. Preoperatively...enoxaparin 40 mg sc, 21.00h evening before surgerymidazolam 7.5 mg orally, 1 h preoperatively (9.30 AM)BP 155/85 mmHgHR 90/min Allergy to anaesthetic agent
  • 5. Intraoperatively...Standard monitoring – ECG, SpO2, NIBPiv line 18 G, left handInduction of anaesthesia (10.40 AM):  sufentanil 30 μg iv  thiopental 350 mg iv  rocuronium 40 mg iv → Rash → Orotracheal intubation (10.43 AM) Allergy to anaesthetic agent
  • 6. Intraoperatively..........deep hypotension – 45/20 mmHg.......difficult ventilation – peak airway pressure 32 cmH20, SpO2 91 %, FiO2 100% → Asistoly → CPR according to ALS algorythm + fluid resuscitation, antihistaminic, steroidAfter 45 minutes....ROSC! Allergy to anaesthetic agent
  • 7. ICU• Cancelled surgery → ICU admission•Vasoactive drugs – excluded POD 2Respiratory support – weaning and extubation POD 9POD 1, MSCT of the brain: normal findingPOD 3, MSCT of the brain: ischemia cortically and subcortically in the right hemisphereNeurological status (POD 7): left hemiplegia with tendency of recovery......Discharge POD 19 – paresis of left hand, patient in contact Allergy to anaesthetic agent
  • 8. Allergy testing (3 months later)Skin test midazolam, propofol, thiopental, sufentanil, soya – NEGATIVE Rocuornium - POSITIVE Allergy to anaesthetic agent
  • 9. Questions to be answered!Incidence of allergy to muscle relaxants/anaesthetics?How to predict it?In case of, what is the alternative? Allergy to anaesthetic agent
  • 10. Statistics....Anaphylaxis in anaesthesia 1/10 000 – 1/ 20 000Grade I - VPseudoanaphylaxis – chemically mediated histamine release50% on NMBAs (leptosucyn, rocuronium) Cross-alergy ! FolcodineAllergy on food no important Allergy to anaesthetic agent
  • 11. THANK YOU!Allergy to anaesthetic agent

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