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Helga Komen Ušljebrka, MD, anaesthesiologistDepartment of Anaesthesiology and Intensive Care               University Hosp...
Patient historyM.P., female, 67 years BMI 27.3 kg/m2Dg: CholelithiasisElective surgery: Laparoscopic cholecystectomyC...
Patient historyPreoperative physical examination:  Respiratory status NA  Hemodinamical status:     BP 140/85 mmHg    ...
Preoperatively...enoxaparin 40 mg sc, 21.00h evening before surgerymidazolam 7.5 mg orally, 1 h preoperatively (9.30 AM)...
Intraoperatively...Standard monitoring – ECG, SpO2, NIBPiv line 18 G, left handInduction of anaesthesia (10.40 AM):   ...
Intraoperatively..........deep hypotension – 45/20 mmHg.......difficult ventilation – peak airway pressure 32 cmH20,    Sp...
ICU•   Cancelled surgery → ICU admission•Vasoactive drugs – excluded POD 2Respiratory support – weaning and extubation PO...
Allergy testing (3 months later)Skin test  midazolam, propofol, thiopental, sufentanil, soya –   NEGATIVE  Rocuornium -...
Questions to be answered!Incidence of allergy to muscle relaxants/anaesthetics?How to predict it?In case of, what is th...
Statistics....Anaphylaxis in anaesthesia 1/10 000 – 1/ 20 000Grade I - VPseudoanaphylaxis – chemically mediated histami...
THANK YOU!Allergy to anaesthetic agent
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Allergy to anaesthetic agent

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Allergy to anaesthetic agent

  1. 1. Helga Komen Ušljebrka, MD, anaesthesiologistDepartment of Anaesthesiology and Intensive Care University Hospital Rijeka, Croatia
  2. 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. 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. 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. 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. 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. 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. 8. Allergy testing (3 months later)Skin test midazolam, propofol, thiopental, sufentanil, soya – NEGATIVE Rocuornium - POSITIVE Allergy to anaesthetic agent
  9. 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. 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. 11. THANK YOU!Allergy to anaesthetic agent

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