title: [Severe anaphylactic reaction to metamizol during subarachnoid anesthesia].
abstract: A 59-year-old man with no relevant medical history underwent a right saphenectomy under subarachnoid anesthesia with mepivacaine. Administration of intravenous metamizol for postoperative analgesia was followed by severe anaphylactic reaction with respiratory failure and ventricular fibrillation. The patient recovered after orotracheal intubation and defibrillation. High serum tryptase levels 2 and 6 hours after the episode and positive skin prick tests confirmed the diagnosis of anaphylactic reaction mediated by immunoglobulin-E antibodies. Anaphylactic reactions to metamizol may be more common than would appear based on reports in the literature. When signs present suddenly with cardiovascular or respiratory involvement, symptomatic treatment should be started even in the absence of cutaneous or mucosal signs and allergy tests should be carried out immediately.
authors.affiliation: Servicio de Anestesiología, Reanimación y Terapéutica de Dolor, Hospital Universitario Mar-Esperanza (IMAS), Barcelona. lmolto@imas.imin.es
authors.forename: L
authors.initials: L
authors.lastname: Moltó
authors.forename: R
authors.initials: R
authors.lastname: Pallarés
authors.forename: J
authors.initials: J
authors.lastname: Castillo
authors.forename: L L
authors.initials: LL
authors.lastname: Gallart
authors.forename: F
authors.initials: F
authors.lastname: Escolano
mesh_terms: D000698:Analgesia / Q000379:methods*; D018712:Analgesics, Non-Narcotic / Q000008:administration & dosage / Q000009:adverse effects*; D000707:Anaphylaxis / Q000139:chemically induced*; D000775:Anesthesia, Spinal; D004177:Dipyrone / Q000008:administration & dosage / Q000009:adverse effects*; D006801:Humans; D007073:Immunoglobulin E / Q000276:immunology; D007431:Intraoperative Complications / Q000139:chemically induced*; D008297:Male; D008875:Middle Aged; D010149:Postoperative Pain / Q000188:drug therapy*; D012131:Respiratory Insufficiency / Q000209:etiology; D013346:Subarachnoid Space; D014693:Ventricular Fibrillation / Q000209:etiology
chemical_list: D018712:Analgesics, Non-Narcotic; D007073:Immunoglobulin E; D004177:Dipyrone