Use of alpha-agonists for management of anaphylaxis occurring under anaesthesia: case studies and review.
Anaphylaxis is an uncommon but serious complication of anaesthesia. Most current guidelines for the management of anaphylaxis list only epinephrine as a vasopressor to use in the event of cardiovascular collapse. We present two cases of anaphylaxis under anaesthesia where return of spontaneous circulation was refractory to epinephrine, but occurred following the administration of the alpha-agonist metaraminol. Potential advantages and disadvantages of using epinephrine in this setting, the role of alpha-agonists and some potential mechanisms accounting for their role in successful management are reviewed.
Heytman
M
M
Department of Anaesthesia, The Townsville Hospital, Douglas, QLD 4814, Australia.
Rainbird
A
A
D000322:Adrenergic Agonists / Q000627:therapeutic use*; D000368:Aged; D000707:Anaphylaxis / Q000139:chemically induced / Q000188:drug therapy*; D000768:Anesthesia, General / Q000009:adverse effects*; D004837:Epinephrine / Q000627:therapeutic use; D006801:Humans; D007431:Intraoperative Complications / Q000139:chemically induced / Q000188:drug therapy*; D008297:Male; D008680:Metaraminol / Q000627:therapeutic use*; D008875:Middle Aged; D017211:Treatment Failure; D014662:Vasoconstrictor Agents / Q000627:therapeutic use
D000322:Adrenergic Agonists; D014662:Vasoconstrictor Agents; D008680:Metaraminol; D004837:Epinephrine