title: Anaphylaxis to isosulfan blue dye during sentinel lymph node biopsy.
abstract: We describe a case of intraoperative anaphylaxis resulting from isosulfan blue (IB) dye, an agent being increasingly used for identification of sentinel lymph nodes. A 45-year-old woman undergoing a left mastectomy with sentinel lymph node biopsy under general endotracheal anesthesia developed severe intraoperative hypotension and tachycardia 10 minutes after subcutaneous injection of IB dye for lymphatic mapping. This was associated with a reduction in pulse oximeter reading to 89%. She was successfully resuscitated using 1 mg of epinephrine intravenously (IV). Invasive arterial and central venous pressures were initiated; her lymph node biopsy was concluded, but the rest of her procedure was canceled. Postoperative workup revealed a high tryptase level indicative of an intraoperative anaphylactic reaction most probably related to the IB dye. Isosulfan blue dye can act as an antigen, causing a full-blown intraoperative anaphylactic reaction. Early recognition and aggressive hemodynamic interventions can reduce morbidity and mortality.
authors.affiliation: Department of General Anesthesiology and Critical Care Medicine, The Cleveland Clinic Foundation, Cleveland, OH 44195, USA.
authors.forename: Sukhjit
authors.initials: S
authors.lastname: Sandhu
authors.forename: Ehab
authors.initials: E
authors.lastname: Farag
authors.forename: Maged
authors.initials: M
authors.lastname: Argalious
mesh_terms: D000707:Anaphylaxis / Q000139:chemically induced* / Q000188:drug therapy*; D001943:Breast Neoplasms / Q000601:surgery*; D001993:Bronchodilator Agents / Q000627:therapeutic use; D044584:Carcinoma, Ductal / Q000601:surgery*; D002405:Catheterization, Central Venous / Q000379:methods; D004396:Coloring Agents / Q000009:adverse effects*; D004837:Epinephrine / Q000627:therapeutic use; D005260:Female; D006801:Humans; D007022:Hypotension / Q000139:chemically induced; D007431:Intraoperative Complications / Q000139:chemically induced / Q000188:drug therapy; D008408:Mastectomy / Q000379:methods; D008875:Middle Aged; D010092:Oximetry / Q000379:methods; D012394:Rosaniline Dyes / Q000009:adverse effects*; D021701:Sentinel Lymph Node Biopsy / Q000379:methods*; D012697:Serine Endopeptidases / Q000097:blood / Q000187:drug effects; D013610:Tachycardia / Q000139:chemically induced; D053802:Tryptases
chemical_list: D001993:Bronchodilator Agents; D004396:Coloring Agents; D012394:Rosaniline Dyes; C025484:iso-sulfan blue; D012697:Serine Endopeptidases; D053802:Tryptases; D004837:Epinephrine