[Anaphylactic shock during the use of high doses of aprotinin in cardiac surgery].
A 77-year-old man was admitted for mitral valve replacement, 46 days after a failed conservative mitral surgery where he received high-dose aprotinin. Twenty minutes after induction of anaesthesia, 250 UPh E of aprotinin were infused intravenously; before the end of this infusion, bronchospasm, systemic hypotension and generalized rash were noted. Immediate treatment included intravenous adrenaline and methylprednisolone; cardiovascular stability was restored after 10 minutes. Immediate histamine liberation was confirmed by the analysis of the time course of the clinical events, a previous contact and positive skin tests. Aprotinin has the antigenic molecular structure of natural proteins. Since 1987, it is used in cardiac surgery to reduce postoperative blood loss: to prevent serious allergic reactions to aprotinin, it is necessary, in patients known to have had previous aprotinin therapy, to perform skin testing with diluted aprotinin before infusion.
Cottineau
C
C
Département d'Anesthésie-Réanimation, CHU, Angers.
Moreau
X
X
Drouet
M
M
De Brux
J L
JL
Brenet
O
O
Delhumeau
A
A
D000368:Aged; D000707:Anaphylaxis / Q000139:chemically induced*; D007611:Aprotinin / Q000009:adverse effects*; D006348:Cardiac Surgical Procedures; D006636:Histamine Release / Q000187:drug effects; D006801:Humans; D007431:Intraoperative Complications / Q000139:chemically induced*; D008297:Male; D008943:Mitral Valve / Q000601:surgery; D012086:Reoperation; D012882:Skin Tests; D014261:Tricuspid Valve / Q000601:surgery
D007611:Aprotinin