Intraoperative recurrence of probable allergic reaction to remifentanil. Case report

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• 作者：Fernando Aguilera-Castro ; ^{ofaguilerac@gmail.com}
• 关键词：Anaphylaxis ; Balanced anesthesia ; Drug hypersensitivity ; Analgesics ; opioid ; Anesthesia ; general
• 刊名：Colombian Journal of Anesthesiology
• 出版年：2017
• 出版时间：January 2017
• 年：2017
• 卷：45
• 期：supp_S1
• 页码：31-35
• 全文大小：463 K
• 卷排序：45

文摘

Although rare, intraoperative anaphylaxis may be life-threatening. Opioids, including remifentanil, have the lowest rates of association with allergic reactions during anaesthesia. Recurrence of anaphylactic reaction after continuation of a remifentanil infusion creates the suspicion of a causal relationship between this agent and the reaction.Case descriptionCase presentation of anaphylactic reaction during balanced anaesthesia in a 19 year-old female patient. At the start of the surgical procedure, the patient developed refractory hypotension and generalized erythema, which responded to vasopressors, antihistamines and the discontinuation of the anaesthetic agents. The remifentanil infusion was reinitiated later in response to the need of increasing the depth of the anaesthesia, and the anaphylactic reaction recurred.ConclusionAny medication or potential allergen to which a patient is exposed during the perioperative period may cause anaphylaxis; the usual culprits are neuromuscular blocking agents (NMBA). In 80% of cases of hypersensitivity to medications, the origin is not immunological; the only way to confirm anaphylaxis is by means of biological and skin testing performed in a unit specializing in allergy and anaesthesia. In this case, confirmation was not possible because, in Colombia, the specific technological and biological resources are lacking.