Masako Yasuda1, Katsuyuki Moriwaki2,3,4,5, Yasuo M Tsutsumi6. 1. Department of Anesthesiology, Critical Care and Pain Medicine, National Hospital Organization Kure-Medical Center Chugoku Cancer Center, 3-1 Aoyamacho, Kure, Hiroshima, 737-0023, Japan. 2. Department of Anesthesiology, Critical Care and Pain Medicine, National Hospital Organization Kure-Medical Center Chugoku Cancer Center, 3-1 Aoyamacho, Kure, Hiroshima, 737-0023, Japan. kmoriwaki1953@icloud.com. 3. Department of Anesthesiology, Hiroshima Hiramatsu Hospital, 11-27 Hijiyama Honmachi, Minami-ku, Hiroshima, 732-0816, Japan. kmoriwaki1953@icloud.com. 4. Department of Anesthesiology and Critical Care, Graduate School of Biomedical and Health Sciences, Hiroshima University, Kasumi 1-2-3 Minami-ku, Hiroshima, 734-8551, Japan. kmoriwaki1953@icloud.com. 5. , Present address: Hiroshima, Japan. kmoriwaki1953@icloud.com. 6. Department of Anesthesiology and Critical Care, Graduate School of Biomedical and Health Sciences, Hiroshima University, Kasumi 1-2-3 Minami-ku, Hiroshima, 734-8551, Japan.
Abstract
BACKGROUND: Prophylactic antibiotics and neuromuscular blocking agents (NMBA) are two of the major causative agents of anaphylaxis after induction of anesthesia. CASE PRESENTATION: 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: 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.
BACKGROUND: Prophylactic antibiotics and neuromuscular blocking agents (NMBA) are two of the major causative agents of anaphylaxis after induction of anesthesia. CASE PRESENTATION: 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: 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.
Authors: Lene H Garvey; Pascale Dewachter; David L Hepner; Paul Michel Mertes; Susanna Voltolini; Russell Clarke; Peter Cooke; Tomaz Garcez; Anne Berit Guttormsen; Didier G Ebo; Philip M Hopkins; David A Khan; Peter Kopac; Mogens Krøigaard; Jose Julio Laguna; Stuart Marshall; Peter Platt; Michael Rose; Vito Sabato; Paul Sadleir; Louise Savic; Sinisa Savic; Kathrin Scherer; Tomonori Takazawa; Gerald W Volcheck; Helen Kolawole Journal: Br J Anaesth Date: 2019-05-24 Impact factor: 9.166
Authors: Didier G Ebo; Margaretha Faber; Jessy Elst; Athina L Van Gasse; Chris H Bridts; Christel Mertens; Luc S De Clerck; Margo M Hagendorens; Vito Sabato Journal: J Allergy Clin Immunol Pract Date: 2018-02-14
Authors: N J N Harper; T M Cook; T Garcez; L Farmer; K Floss; S Marinho; H Torevell; A Warner; K Ferguson; J Hitchman; W Egner; H Kemp; M Thomas; D N Lucas; S Nasser; S Karanam; K-L Kong; S Farooque; M Bellamy; N McGuire Journal: Br J Anaesth Date: 2018-05-21 Impact factor: 9.166