Helga Komen Ušljebrka, MD, anaesthesiologist Department of Anaesthesiology and Intensive

CareUniversity Hospital Rijeka, Croatia

Patient historyM.P., female, 67 yearsBMI 27.3 kg/m2

Dg: CholelithiasisElective surgery: Laparoscopic

cholecystectomy

Comorbidity: Hypotireosis, Hypertension, Hyperlipoproteinemy

Th: levothyroxine 25 μg, cilazapril 2.5 mgNo previous operations (general or regional

anaesthesia)Allergy to anaesthetic agent

Preoperative physical examination: Respiratory status NAHemodinamical 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: ǾAllergy to anaesthetic agent

Patient history

enoxaparin 40 mg sc, 21.00h evening before surgery

midazolam 7.5 mg orally, 1 h preoperatively (9.30 AM)

BP 155/85 mmHgHR 90/min

Allergy to anaesthetic agent

Preoperatively...

Standard monitoring – ECG, SpO2, NIBPiv line 18 G, left hand

Induction of anaesthesia (10.40 AM): sufentanil 30 μg ivthiopental 350 mg ivrocuronium 40 mg iv → Rash

→ Orotracheal intubation (10.43 AM)

Allergy to anaesthetic agent

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

Intraoperatively...

• Cancelled surgery → ICU admission

• Vasoactive drugs – excluded POD 2Respiratory support – weaning and extubation POD 9

POD 1, MSCT of the brain: normal findingPOD 3, MSCT of the brain: ischemia cortically and

subcortically in the right hemisphereNeurological status (POD 7): left hemiplegia with

tendency of recovery......

Discharge POD 19 – paresis of left hand, patient in contact

Allergy to anaesthetic agent

ICU

Allergy testing (3 months later)

Skin test

midazolam, propofol, thiopental, sufentanil, soya – NEGATIVE

Rocuornium - POSITIVE

Allergy to anaesthetic agent

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

Statistics....Anaphylaxis in anaesthesia 1/10 000 – 1/

20 000Grade I - VPseudoanaphylaxis – chemically mediated

histamine release50% on NMBAs (leptosucyn, rocuronium)

Cross-alergy! Folcodine

Allergy on food no importantAllergy to anaesthetic agent

THANK YOU!

Allergy to anaesthetic agent