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Moreau A, Gouel-Chéron A, Roland E, McGee K, Plaud B, Blet A. Allergie peranesthésique : revue et guide de bonnes pratiques. ANESTHÉSIE & RÉANIMATION 2023. [DOI: 10.1016/j.anrea.2023.01.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/19/2023]
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2
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Dejoux A, de Chaisemartin L, Bruhns P, Longrois D, Gouel-Chéron A. Neuromuscular blocking agent induced hypersensitivity reaction exploration: an update. Ugeskr Laeger 2023; 40:95-104. [PMID: 36301083 DOI: 10.1097/eja.0000000000001765] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Acute hypersensitivity reactions (AHRs) occurring in present-day anaesthesia can have severe, sometimes fatal, consequences and their incidence is increasing. The most frequent allergens responsible for AHR during anaesthesia are neuromuscular blocking agents (NMBAs) (70% of the cases) followed by antibiotics (18%), patent blue dye and methylene blue dye (5%), and latex (5%). Following an AHR, strategies for subsequent anaesthetic procedures (especially the choice of an NMBA) may be difficult to formulate due to inconclusive diagnostic analysis in up to 30% of AHRs. Current diagnosis of AHR relies on the detection of mast cell degranulation products and drug-specific type E immunoglobulins (IgE) in order to document an IgE-mediated anaphylaxis (IgE endotype). Nonetheless, other IgE-independent pathways can be involved in AHR, but their detection is not currently available in standard situations. The different mechanisms (endotypes) involved in peri-operative AHR may contribute to the inconclusive diagnostic work-up and this generates uncertainty concerning the culpable drug and strategy for subsequent anaesthetic procedures. This review provides details on the IgE endotype; an update on non-IgE related endotypes and the novel diagnostic tools that could characterise them. This detailed update is intended to provide explicit clinical reasoning tools to the anaesthesiologist faced with an incomplete AHR diagnostic work-up and to facilitate the decision-making process regarding anaesthetic procedures following an AHR to NMBAs.
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Affiliation(s)
- Alice Dejoux
- From the Institut Pasteur, Université de Paris, Unit of Antibodies in Therapy and Pathology, Inserm UMR1222 (AD, LdC, PB, AGC), Immunology Department, DMU BIOGEM, Bichat Hospital, AP-HP (LdC), Université Paris-Saclay, Inserm, Inflammation, Microbiome and Immunosurveillance, Châtenay-Malabry (LdC), Anaesthesiology and Critical Care Medicine Department, DMU PARABOL, Bichat Hospital, AP-HP (DL, AGC), Université de Paris, FHU PROMICE (DL), Anaesthesiology and Critical Care Medicine Department, DMU PARABOL, Bichat-Claude Bernard and Louis Mourier Hospitals, APHP (DL), INSERM1148, Paris, France (DL), and Biostatistics Research Branch, Division of Clinical Research, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland, USA (AGC)
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Gouel-Cheron A, Neukirch C, Kantor E, Malinovsky JM, Tacquard C, Montravers P, Mertes PM, Longrois D. Clinical reasoning in anaphylactic shock: addressing the challenges faced by anaesthesiologists in real time: A clinical review and management algorithms. Eur J Anaesthesiol 2021; 38:1158-1167. [PMID: 33973926 DOI: 10.1097/eja.0000000000001536] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Acute hypersensitivity reactions to drugs occur infrequently during anaesthesia and the peri-operative period. When clinical presentation includes the classical triad, erythema, cardiovascular abnormalities and increased airway pressure, the diagnosis is evident and the challenge is to prescribe a therapeutic regimen according to guidelines and to manage refractory signs in a timely manner. In many situations, however, the initial clinical signs are isolated, such as increased airway pressure or arterial hypotension. Rendering a differential diagnosis with causes and mechanisms other than acute hypersensitivity reactions (AHRs) is difficult, delaying treatment with possible worsening of the clinical signs, and even death, in previously healthy individuals. In these difficult diagnostic situations, clinical reasoning is mandatory, and guidelines do not explicitly explain the elements on which clinical reasoning can be built. In this article, based on clinical evidence whenever available, experimental data and pathophysiology, we propose algorithms that have been evaluated by experts. The goal of these algorithms is to provide explicit elements on which the differential diagnosis of AHRs can be made, accelerating the implementation of adequate therapy.
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Affiliation(s)
- Aurelie Gouel-Cheron
- From the Anaesthesiology and Critical Care Medicine Department, DMU PARABOL, Bichat Hospital, AP-HP (AGC, EK, PM, DL), Antibody in Therapy and Pathology, Pasteur Institute, UMR 1222 INSERM, Paris, France (AGC), Biostatistics Research Branch, Division of Clinical Research, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD, USA (AGC), Pulmonology Department, Bichat Hospital, AP-HP, Paris University (CN), INSERM UMR 1152, Paris University, DHU FIRE, Paris (CN, PM), Anaesthesiology and Critical Care Medicine Department, Maison Blanche Hospital, Centre Hospitalier Universitaire de Reims, Reims (JM-M), Anaesthesiology and Critical Care Medicine Department, Nouvel Hôpital Civil, Hôpitaux Universitaires de Strasbourg (CT, PM-M), Paris University (PM, DL), EA 3072, Institut de Physiologie, FMTS, Faculté de Médecine de Strasbourg, Université de Strasbourg, Strasbourg (PM-M) and INSERM1148, Paris, France (DL)
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Beutier H, Hechler B, Godon O, Wang Y, Gillis CM, de Chaisemartin L, Gouel-Chéron A, Magnenat S, Macdonald LE, Murphy AJ, Chollet-Martin S, Longrois D, Gachet C, Bruhns P, Jönsson F. Platelets expressing IgG receptor FcγRIIA/CD32A determine the severity of experimental anaphylaxis. Sci Immunol 2019; 3:3/22/eaan5997. [PMID: 29654057 DOI: 10.1126/sciimmunol.aan5997] [Citation(s) in RCA: 52] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2017] [Revised: 12/04/2017] [Accepted: 02/16/2018] [Indexed: 12/14/2022]
Abstract
Platelets are key regulators of vascular integrity; however, their role in anaphylaxis, a life-threatening systemic allergic reaction characterized by the loss of vascular integrity and vascular leakage, remains unknown. Anaphylaxis is a consequence of inappropriate cellular responses triggered by antibodies to generally harmless antigens, resulting in a massive mediator release and rapidly occurring organ dysfunction. Human platelets express receptors for immunoglobulin G (IgG) antibodies and can release potent mediators, yet their contribution to anaphylaxis has not been previously addressed in mouse models, probably because mice do not express IgG receptors on platelets. We investigated the contribution of platelets to IgG-dependent anaphylaxis in human IgG receptor-expressing mouse models and a cohort of patients suffering from drug-induced anaphylaxis. Platelet counts dropped immediately and markedly upon anaphylaxis induction only when they expressed the human IgG receptor FcγRIIA/CD32A. Platelet depletion attenuated anaphylaxis, whereas thrombocythemia substantially worsened its severity. FcγRIIA-expressing platelets were directly activated by IgG immune complexes in vivo and were sufficient to restore susceptibility to anaphylaxis in resistant mice. Serotonin released by activated platelets contributed to anaphylaxis severity. Data from a cohort of patients suffering from drug-induced anaphylaxis indicated that platelet activation was associated with anaphylaxis severity and was accompanied by a reduction in circulating platelet numbers. Our findings identify platelets as critical players in IgG-dependent anaphylaxis and provide a rationale for the design of platelet-targeting strategies to attenuate the severity of anaphylactic reactions.
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Affiliation(s)
- Héloïse Beutier
- Institut Pasteur, Department of Immunology, Unit of Antibodies in Therapy and Pathology, Paris, France.,INSERM U1222, Paris, France.,Université Pierre et Marie Curie, Paris, France
| | - Béatrice Hechler
- Université de Strasbourg, INSERM, Etablissement Français du Sang (EFS) Grand Est, Biologie et Pharmacologie des plaquettes sanguines (BPPS) UMR_S1255, Fédération de Médecine Translationnelle de Strasbourg (FMTS), F-67000 Strasbourg, France
| | - Ophélie Godon
- Institut Pasteur, Department of Immunology, Unit of Antibodies in Therapy and Pathology, Paris, France.,INSERM U1222, Paris, France
| | - Yu Wang
- Institut Pasteur, Department of Immunology, Unit of Antibodies in Therapy and Pathology, Paris, France.,INSERM U1222, Paris, France.,Université Diderot Paris VII, Paris, France
| | - Caitlin M Gillis
- Institut Pasteur, Department of Immunology, Unit of Antibodies in Therapy and Pathology, Paris, France.,INSERM U1222, Paris, France.,Université Pierre et Marie Curie, Paris, France
| | - Luc de Chaisemartin
- Unité Fonctionnelle Auto-immunité et Hypersensibilités, Hôpital Bichat, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France.,UMR996-Inflammation, Chemokines et Immunopathology, INSERM, Université Paris-Sud, Université Paris-Saclay, Châtenay-Malabry, France
| | - Aurélie Gouel-Chéron
- Institut Pasteur, Department of Immunology, Unit of Antibodies in Therapy and Pathology, Paris, France.,INSERM U1222, Paris, France.,Département d'Anesthésie-Réanimation, Hôpital Bichat, AP-HP, Paris, France
| | - Stéphanie Magnenat
- Université de Strasbourg, INSERM, Etablissement Français du Sang (EFS) Grand Est, Biologie et Pharmacologie des plaquettes sanguines (BPPS) UMR_S1255, Fédération de Médecine Translationnelle de Strasbourg (FMTS), F-67000 Strasbourg, France
| | | | | | | | - Sylvie Chollet-Martin
- Unité Fonctionnelle Auto-immunité et Hypersensibilités, Hôpital Bichat, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France.,UMR996-Inflammation, Chemokines et Immunopathology, INSERM, Université Paris-Sud, Université Paris-Saclay, Châtenay-Malabry, France
| | - Dan Longrois
- Département d'Anesthésie-Réanimation, Hôpital Bichat, AP-HP, Paris, France.,INSERM UMR1152, Université Paris Diderot Paris 7, Paris, France
| | - Christian Gachet
- Université de Strasbourg, INSERM, Etablissement Français du Sang (EFS) Grand Est, Biologie et Pharmacologie des plaquettes sanguines (BPPS) UMR_S1255, Fédération de Médecine Translationnelle de Strasbourg (FMTS), F-67000 Strasbourg, France
| | - Pierre Bruhns
- Institut Pasteur, Department of Immunology, Unit of Antibodies in Therapy and Pathology, Paris, France. .,INSERM U1222, Paris, France
| | - Friederike Jönsson
- Institut Pasteur, Department of Immunology, Unit of Antibodies in Therapy and Pathology, Paris, France. .,INSERM U1222, Paris, France
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Gouel-Chéron A, de Chaisemartin L, Jönsson F, Nicaise-Roland P, Granger V, Sabahov A, Guinnepain MT, Chollet-Martin S, Bruhns P, Neukirch C, Longrois D. Low end-tidal CO2 as a real-time severity marker of intra-anaesthetic acute hypersensitivity reactions. Br J Anaesth 2017; 119:908-917. [DOI: 10.1093/bja/aex260] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/10/2017] [Indexed: 01/03/2023] Open
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Ouzzad O, Kechna H, Moudden MK, Chkoura K, Hanafi SM. [Cardiac arrest during liver hydatid cyst surgery]. Pan Afr Med J 2015; 22:32. [PMID: 26664533 PMCID: PMC4662535 DOI: 10.11604/pamj.2015.22.32.6909] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2015] [Accepted: 09/01/2015] [Indexed: 12/05/2022] Open
Abstract
L'hydatidose est une pathologie fréquente qui reste encore endémique au Maroc. Sa localisation privilégiée est le foie. Son traitement repose essentiellement sur la chirurgie. Celui-ci est parfois incriminé dans la survenue de réactions allergiques sévères pouvant menacer le pronostic vital. Nous rapportons un nouveau cas de réaction anaphylactique sévère de grade IV peropératoire au cours d'une chirurgie de kystes hydatiques multiples du foie. Nous insistons sur la nécessité de sa reconnaissance rapide afin d'instaurer rapidement un traitement efficace. La prévention de cet accident est basée sur des précautions chirurgicales pour éviter les fuites ou les ruptures accidentelles peropératoires des kystes hydatiques.
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Affiliation(s)
- Omar Ouzzad
- Pôle d'anesthésie-Réanimation-Urgences, Hôpital Militaire Moulay Ismail, Meknès, Maroc
| | - Hicham Kechna
- Pôle d'anesthésie-Réanimation-Urgences, Hôpital Militaire Moulay Ismail, Meknès, Maroc
| | | | - Khalid Chkoura
- Pôle d'anesthésie-Réanimation-Urgences, Hôpital Militaire Moulay Ismail, Meknès, Maroc
| | - Sidi Mohamed Hanafi
- Pôle d'anesthésie-Réanimation-Urgences, Hôpital Militaire Moulay Ismail, Meknès, Maroc
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Sirieix D, Latreille S, Raft J. [Rapid hemodynamic recovery after early epinephrine and sugammadex co-administration during rocuronium-induced anaphylactic reaction]. ACTA ACUST UNITED AC 2014; 33:602-3. [PMID: 25443042 DOI: 10.1016/j.annfar.2014.08.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2014] [Accepted: 08/18/2014] [Indexed: 12/17/2022]
Affiliation(s)
- D Sirieix
- Groupe des anesthésistes réanimateurs (GARHPA), hôpital d'Antony, 1, rue Velpeau, 92160 Antony, France.
| | - S Latreille
- Département d'anesthésie-réanimation, Nancy université, institut de cancérologie de Lorraine-Alexis-Vautrin, avenue de Bourgogne, 54511 Vandœuvre-les-Nancy, France
| | - J Raft
- Département d'anesthésie-réanimation, Nancy université, institut de cancérologie de Lorraine-Alexis-Vautrin, avenue de Bourgogne, 54511 Vandœuvre-les-Nancy, France
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Lonjaret L, Lairez O, Minville V, Geeraerts T. Optimal perioperative management of arterial blood pressure. Integr Blood Press Control 2014; 7:49-59. [PMID: 25278775 PMCID: PMC4178624 DOI: 10.2147/ibpc.s45292] [Citation(s) in RCA: 86] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Perioperative blood pressure management is a key factor of patient care for anesthetists, as perioperative hemodynamic instability is associated with cardiovascular complications. Hypertension is an independent predictive factor of cardiac adverse events in noncardiac surgery. Intraoperative hypotension is one of the most encountered factors associated with death related to anesthesia. In the preoperative setting, the majority of antihypertensive medications should be continued until surgery. Only renin-angiotensin system antagonists may be stopped. Hypertension, especially in the case of mild to moderate hypertension, is not a cause for delaying surgery. During the intraoperative period, anesthesia leads to hypotension. Hypotension episodes should be promptly treated by intravenous vasopressors, and according to their etiology. In the postoperative setting, hypertension predominates. Continuation of antihypertensive medications and postoperative care may be insufficient. In these cases, intravenous antihypertensive treatments are used to control blood pressure elevation.
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Affiliation(s)
- Laurent Lonjaret
- Department of Anesthesiology and Intensive Care, Clinique des eaux claires, Baie-Mahault, France
| | - Olivier Lairez
- Department of Cardiology, University Toulouse III - Paul Sabatier, Toulouse, France
| | - Vincent Minville
- Department of Anesthesiology and Intensive Care, University Hospital of Toulouse, University Toulouse III - Paul Sabatier, Toulouse, France
| | - Thomas Geeraerts
- Department of Anesthesiology and Intensive Care, University Hospital of Toulouse, University Toulouse III - Paul Sabatier, Toulouse, France
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Abstract
Perioperative anaphylaxis is a life-threatening condition with an estimated prevalence of 1:3,500 to 1:20,000 procedures and a mortality rate of up to 9 %. Clinical presentation involves signs such as skin rash, urticaria, angioedema, bronchospasm, tachycardia, bradycardia, and hypotension. Prompt recognition and treatment is of utmost importance to the patient's prognosis, since clinical deterioration can develop rapidly. Epinephrine is the main treatment drug, and its use should not be postponed, since delayed administration is associated with increased mortality. Elevated levels of serum tryptase help to confirm the diagnosis. The main agents involved in IgE-mediated perioperative anaphylaxis are neuromuscular blocking agents, latex, antibiotics, hypnotics, opioids, and colloids. Specific investigation should be conducted 4 to 6 weeks after the reaction and relies on skin tests, serum-specific IgE, and challenge procedures. This review aims to discuss the main aspects of perioperative anaphylaxis: risk factors, diagnosis, treatment, culprit agents, specific investigation, and preventive measures.
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Reitter M, Petitpain N, Latarche C, Cottin J, Massy N, Demoly P, Gillet P, Mertes PM. Fatal anaphylaxis with neuromuscular blocking agents: a risk factor and management analysis. Allergy 2014; 69:954-9. [PMID: 24813248 DOI: 10.1111/all.12426] [Citation(s) in RCA: 71] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/08/2014] [Indexed: 12/21/2022]
Abstract
BACKGROUND Anaphylactic reactions to neuromuscular blocking agents (NMBAs) can be severe and even fatal. Our aim was to evaluate mortality rate in France from anaphylactic reactions to NMBAs, to identify risk factors for a fatal outcome, and to describe management of the cases that proved fatal. METHODS The French National Pharmacovigilance Database was queried for reports of NMBA anaphylaxis that occurred between January 2000 and December 2011. A questionnaire was sent to regional pharmacovigilance centers to obtain further information on the management of cases with a fatal outcome. RESULTS Two thousand and twenty-two cases of NMBA hypersensitivity were retrieved, of which 84 were fatal (4.1%). Among the 1247 cases of severe NMBA anaphylaxis (grades 3 and 4), independent risk factors associated with a fatal outcome in a multivariate analysis were male gender (female gender: OR = 0.4; 95% CI 0.2-0.7; P = 0.0004), an emergency setting (OR = 2.6; 95% CI 1.5-4.6; P = 0.0007), a history of hypertension (OR = 2.5; 95% CI 1.5-4.4; P = 0.0010) or of other cardiovascular disease (OR = 4.4; 95% CI 2.4-8.1; P < 0.0001), obesity (OR = 2.4; 95% CI 1.1-5.3; P = 0.0376), and ongoing beta-blocker treatment (OR = 4.2; 95% CI 1.8-9.8; P = 0.0011). All 31 patients with a fatal outcome received epinephrine in a titrated manner according to international guidelines. CONCLUSION Obese males with a history of cardiovascular disease receiving ongoing beta-blocker treatment and undergoing surgery in an emergency setting were at high risk of a fatal outcome after NMBA-induced anaphylaxis. Some epinephrine-resistant cases may play a role in our high mortality rate. New therapeutic approaches need to be developed to treat these cases.
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Affiliation(s)
- M. Reitter
- Department of Anesthesia; University Hospital of Nancy; Nancy France
| | - N. Petitpain
- Regional Pharmacovigilance Centre of Nancy; University Hospital of Nancy; Nancy France
| | - C. Latarche
- Department of Epidemiology; University Hospital of Nancy; Vandoeuvre lès Nancy France
| | - J. Cottin
- Regional Pharmacovigilance Centre of Lyon; University Hospital of Lyon; Lyon France
| | - N. Massy
- Regional Pharmacovigilance Centre of Rouen; University Hospital of Rouen; Rouen France
| | - P. Demoly
- Department of Allergology; University Hospital of Montpellier; Montpellier France
| | - P. Gillet
- Department of Clinical Pharmacology; University Hospital of Nancy; Nancy France
| | - P. M. Mertes
- Department of Anesthesia; CHRU of Strasbourg; Nouvel Hôpital Civil; Strasbourg France
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A new option for the treatment of anaphylaxis linked to steroidal neuromuscular blockers: How much value should we grant to case reports? Can J Anaesth 2014; 61:511-8. [DOI: 10.1007/s12630-014-0150-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2014] [Accepted: 03/13/2014] [Indexed: 12/17/2022] Open
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Ziadi A, Ejlaidi A, Hachimi A, Elkhayari A, Samkaoui MA. [Intraoperative cardiac arrest of a hepatic hydatid cyst surgery]. ACTA ACUST UNITED AC 2014; 33:195-6. [PMID: 24636789 DOI: 10.1016/j.annfar.2014.01.018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2013] [Accepted: 01/27/2014] [Indexed: 11/16/2022]
Affiliation(s)
- A Ziadi
- Service d'anesthésie réanimation, CHU Mohammed VI, faculté de médecine et de pharmacie, université Cadi Ayyad, Marrakech, Maroc
| | - A Ejlaidi
- Service d'anesthésie réanimation, CHU Mohammed VI, faculté de médecine et de pharmacie, université Cadi Ayyad, Marrakech, Maroc.
| | - A Hachimi
- Service d'anesthésie réanimation, CHU Mohammed VI, faculté de médecine et de pharmacie, université Cadi Ayyad, Marrakech, Maroc
| | - A Elkhayari
- Service d'anesthésie réanimation, CHU Mohammed VI, faculté de médecine et de pharmacie, université Cadi Ayyad, Marrakech, Maroc
| | - M A Samkaoui
- Service d'anesthésie réanimation, CHU Mohammed VI, faculté de médecine et de pharmacie, université Cadi Ayyad, Marrakech, Maroc
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Alansari M, Alsanouri I. Atypical intraoperative anaphylactic shock with ECG changes secondary to non-ruptured hepatic hydatid cyst. BMJ Case Rep 2013; 2013:bcr-2012-008442. [PMID: 23370961 DOI: 10.1136/bcr-2012-008442] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
A 62-year-old woman was admitted to the hospital for removal of hydatid cyst from the liver. Intraoperatively, the patient suddenly became hypotensive with tachycardia and ST segment elevation. There was no erythema, bronchospasm or desaturation. Anaesthetic agents were stopped and oxygen fraction was increased. In view of the recurrence of hypotension, she was admitted to the intensive care unit (ICU) without completion of surgery. She was successfully resuscitated and acute myocardial infarction was ruled out. She was managed for the possibility of anaphylaxis with hydration, dopamine, antihistamin and hydrocortisone. After stabilisation, she was taken back to the theatre and the cyst was then removed. Histopathology confirmed hydatid disease of the liver. The patient was discharged from the ICU and then from the hospital in 6 days. Anaphylaxis secondary to hydatid disease is uncommon; however, the possibility of such a diagnosis in all patients with non-ruptured hydatid disease in the endemic areas that develop intraoperative shock should be considered.
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Affiliation(s)
- Mariam Alansari
- Department of Adult Critical Care Medicine, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia.
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Abstract
PURPOSE OF REVIEW This article aims to make a review of the up-to-date knowledge on anaphylaxis and outline the recent advances on pathophysiology, diagnosis, and management of anaphylaxis. RECENT FINDINGS New data confirm the increase in prevalence of anaphylaxis and emphasize immunopathologic mechanisms. However, anaphylaxis is often underdiagnosed and guidelines are poorly applied, particularly in emergency departments. SUMMARY An improvement of rapid diagnosis and treatment combined with education of population will decrease mortality and morbidity of anaphylaxis.
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Mertes PM, Demoly P, Malinovsky JM. Complications anaphylactiques et anaphylactoïdes de l’anesthésie générale. ACTA ACUST UNITED AC 2012. [DOI: 10.1016/s0246-0289(12)59003-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
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Bensghir M, Fjouji S, Bouhabba N, Ahtil R, Traore A, Azendour H, Kamili ND. Anaphylactic shock during hydatid cyst surgery. Saudi J Anaesth 2012; 6:161-4. [PMID: 22754444 PMCID: PMC3385260 DOI: 10.4103/1658-354x.97031] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Intraoperative anaphylactic shock is an unusual complication. Different causes can be involved. Surgery of hydatid cyst is rarely responsible. About a case report of anaphylactic shock due to hydatid cyst surgery, the authors discuss the mechanisms, principles of treatment, and prevention measures of this complication.
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Affiliation(s)
- Mustapha Bensghir
- Department of Anaesthesiology, Military Hospital Med V Rabat, University of Med V Suissi Rabat, Morocco
| | - Salaheddine Fjouji
- Department of Anaesthesiology, Military Hospital Med V Rabat, University of Med V Suissi Rabat, Morocco
| | - Najib Bouhabba
- Department of Anaesthesiology, Military Hospital Med V Rabat, University of Med V Suissi Rabat, Morocco
| | - Redouane Ahtil
- Department of Anaesthesiology, Military Hospital Med V Rabat, University of Med V Suissi Rabat, Morocco
| | - Alain Traore
- Department of Anaesthesiology, Military Hospital Med V Rabat, University of Med V Suissi Rabat, Morocco
| | - Hicham Azendour
- Department of Anaesthesiology, Military Hospital Med V Rabat, University of Med V Suissi Rabat, Morocco
| | - Nordine Drissi Kamili
- Department of Anaesthesiology, Military Hospital Med V Rabat, University of Med V Suissi Rabat, Morocco
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Raft J, Leclercq M, Longrois D, Meistelman C. Récupération hémodynamique et ventilatoire rapide après injection de sugammadex lors d’un choc anaphylactique au rocuronium, réfractaire au traitement conventionnel. ACTA ACUST UNITED AC 2012; 31:158-61. [DOI: 10.1016/j.annfar.2011.10.023] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2011] [Accepted: 10/26/2011] [Indexed: 12/17/2022]
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