[Successful extracorporeal resuscitation of a probable perioperative anaphylactic shock due to atracurium].
We report the case of a 55-year-old woman ASA 2 scheduled for a cholecystectomy, who presented 25 minutes after the induction, a circulatory arrest probably due to a cardiac anaphylaxis attributed to atracurium. After 60 minutes of futile resuscitation without any spontaneous cardiac rhythm a percutaneous cardiopulmonary bypass (CPB) was initiated. Twenty minutes later and after three external electric shocks electric cardiac activity returned normal. The weaning was possible 120 minutes later with catecholamine support. She left the intensive care unit on postoperative day seven after a laparotomy secondary to splenic injury due to intensive cardiopulmonary resuscitation. She was discharged home without any neurologic or cardiac sequellae. Biological assessment done during the circulatory arrest and cutaneous tests performed ten weeks later confirmed an isolated allergy to atracurium. CPB is the most efficient support in case of reversible cardiac arrest but unfortunately the less accessible outside from cardiac surgery unit.
Lafforgue
E
E
Polyclinique Saint-Roch, 43 rue du Faubourg-Saint-Jaumes, 34967 Montpellier cedex 02, France.
Sleth
J-C
JC
Pluskwa
F
F
Saizy
C
C
D000707:Anaphylaxis / Q000139:chemically induced / Q000628:therapy*; D001279:Atracurium / Q000009:adverse effects*; D002315:Cardiopulmonary Bypass; D016887:Cardiopulmonary Resuscitation / Q000009:adverse effects / Q000379:methods*; D017081:Cholecystectomy, Laparoscopic; D003131:Combined Modality Therapy; D004211:Disseminated Intravascular Coagulation / Q000209:etiology; D004554:Electric Countershock; D004837:Epinephrine / Q000627:therapeutic use; D005260:Female; D005665:Furosemide / Q000627:therapeutic use; D006323:Heart Arrest / Q000209:etiology / Q000628:therapy; D006465:Hemoperitoneum / Q000209:etiology; D006801:Humans; D007431:Intraoperative Complications / Q000139:chemically induced* / Q000628:therapy; D008875:Middle Aged; D003473:Neuromuscular Nondepolarizing Agents / Q000009:adverse effects*; D012121:Respiration, Artificial; D013156:Splenectomy; D013161:Splenic Rupture / Q000209:etiology / Q000601:surgery
D003473:Neuromuscular Nondepolarizing Agents; D001279:Atracurium; D005665:Furosemide; D004837:Epinephrine