title: [Case of anaphylactic shock induced by an antibiotic after induction of anesthesia].
abstract: We report a case of anaphylactic shock induced by an antibiotic administrated after induction. A 39-year-old man was scheduled for removal of right adrenal tumor. After insertion of an epidural catheter, anesthesia was induced with an intravenous bolus injection of fentanyl 100 microg, propofol 130 mg and vecuronium 6 mg. The trachea was intubated smoothly and anesthesia was maintained with sevoflurane. Sultamicillin tosilate was administrated intravenously. Soon, ephedrine 12 mg was given intravenously because his blood pressures decreased. However, his blood pressure did not recover, but fell down to 35/22 mmHg. He was turned to head-down position, and 100% oxygen was administrated. Following epinephrine 0.1 mg injection, his blood pressure increased to 80/40 mmHg. Epinephrine at 0.005-0.02 microg x kg(-1) x min(-1) was infused continuously to maintain his blood pressure. We found erhythemia on his face, shoulders and arms. Hydrocortisone sodium succinate and acetate Ringer's solution were administrated to treat his anaphylactic shock and the surgery was postponed. The blood samples indicated that this event was IgE-mediated anaphylactic reaction. From his past history, penicillin allergy was confirmed. The surgery was rescheduled and anesthesia was managed in the same way as previous one. Surgery was successfully performed using levofloxacin, which had been taken orally before induction of anesthesia.
authors.affiliation: Department of Anesthesiology, Jichi Medical University, Tochigi 329-0498.
authors.forename: Shinichiro
authors.initials: S
authors.lastname: Tanaka
authors.forename: Masaaki
authors.initials: M
authors.lastname: Satoh
authors.forename: Yoshihiro
authors.initials: Y
authors.lastname: Hirabayashi
authors.forename: Shin
authors.initials: S
authors.lastname: Nunomiya
authors.forename: Norimasa
authors.initials: N
authors.lastname: Seo
mesh_terms: D000310:Adrenal Gland Neoplasms / Q000601:surgery; D000315:Adrenalectomy; D000328:Adult; D000667:Ampicillin / Q000008:administration & dosage / Q000009:adverse effects; D000707:Anaphylaxis / Q000139:chemically induced* / Q000175:diagnosis; D000767:Anesthesia, Epidural; D000768:Anesthesia, General; D000900:Anti-Bacterial Agents / Q000008:administration & dosage / Q000009:adverse effects*; D015415:Biomarkers / Q000097:blood; D006632:Histamine / Q000097:blood; D006801:Humans; D007262:Infusions, Intravenous; D007430:Intraoperative Care; D008297:Male; D013407:Sulbactam / Q000008:administration & dosage / Q000009:adverse effects; D053802:Tryptases / Q000097:blood
chemical_list: D000900:Anti-Bacterial Agents; D015415:Biomarkers; C035444:sultamicillin; D000667:Ampicillin; D006632:Histamine; D053802:Tryptases; D013407:Sulbactam