title: Kinin-mediated anaphylactoid reaction implicated in acute intra-operative pulseless electrical activity.
abstract: A 65-year-old patient undergoing total hip replacement under general anaesthesia suffered acute pulseless electrical activity with a fatal outcome. A kinin-mediated analphylactoid reaction following administration of a polygeline plasma expander (Haemaccel) was implicated by in vitro testing. This case report illustrates the diagnostic difficulties posed by non-histaminoid anaphylactoid reactions and the resistance to epinephrine of kinin-mediated hypotension.
authors.affiliation: Department of Respiratory Medicine, James Connolly Memorial Hospital, Dublin 15, Ireland.
authors.forename: S
authors.initials: S
authors.lastname: O'Sullivan
authors.forename: J P
authors.initials: JP
authors.lastname: McElwain
authors.forename: T S
authors.initials: TS
authors.lastname: Hogan
mesh_terms: D000368:Aged; D000707:Anaphylaxis / Q000139:chemically induced* / Q000378:metabolism; D000768:Anesthesia, General; D019644:Arthroplasty, Replacement, Hip / Q000009:adverse effects; D016757:Death, Sudden, Cardiac / Q000209:etiology*; D004335:Drug and Narcotic Control; D017809:Fatal Outcome; D006801:Humans; D007022:Hypotension / Q000139:chemically induced / Q000378:metabolism; D007705:Kinins / Q000378:metabolism*; D008297:Male; D010952:Plasma Substitutes / Q000009:adverse effects*; D011097:Polygeline / Q000009:adverse effects*; D011674:Pulse
chemical_list: D007705:Kinins; D010952:Plasma Substitutes; D011097:Polygeline