title: Case report: fentanyl-associated intraoperative anaphylaxis with pulmonary edema.
abstract: OBJECTIVE
  To describe an atypical presentation of intraoperative anaphylaxis due to fentanyl.
  
  
  METHODS
  A 40-yr-old otherwise healthy woman was admitted for abdominal hysterectomy. She denied any drug allergies or past adverse anesthetic reactions. Physical examination, vital signs, and laboratory findings were all within normal limits. Twenty minutes after induction of general anesthesia with propofol, lidocaine, fentanyl, and rocuronium, she developed sudden onset of hypotension and bronchospasm. She was treated with fluids and epinephrine, but nonetheless required mechanical ventilation for 48 hr. Chest x-ray revealed pulmonary edema which resolved over two days. She recovered completely and was discharged home. Subsequent skin testing showed reactions to fentanyl and succinylcholine. Because the patient had not received succinylcholine, the cause of her anaphylaxis was attributed to fentanyl. The patient later returned for her hysterectomy and tolerated spinal anesthesia with bupivacaine and morphine.
  
  
  CONCLUSIONS
  Anaphylaxis is a fulminant, unexpected, IgE-mediated allergic reaction which can be triggered by multiple agents. Common causative agents include neuromuscular blocking drugs, latex, antibiotics, colloids, hypnotics, and opioids. Fentanyl, however, is an extremely unusual cause of anaphylaxis. Pulmonary edema, although uncommon in anaphylaxis, can be a prominent feature, as was the case with this patient.
authors.affiliation: Department of Regional Practice Anesthesiology, The Cleveland Clinic, Ohio, USA. cummink2@ccf.org
authors.forename: Kenneth C
authors.initials: KC
authors.lastname: Cummings
authors.forename: Katherina
authors.initials: K
authors.lastname: Arnaut
mesh_terms: D000328:Adult; D000701:Analgesics, Opioid / Q000009:adverse effects*; D000707:Anaphylaxis / Q000175:diagnosis / Q000209:etiology* / Q000628:therapy; D000768:Anesthesia, General; D001993:Bronchodilator Agents / Q000627:therapeutic use; D004837:Epinephrine / Q000627:therapeutic use; D005260:Female; D005283:Fentanyl / Q000009:adverse effects*; D006801:Humans; D007022:Hypotension / Q000139:chemically induced / Q000188:drug therapy; D007044:Hysterectomy; D007431:Intraoperative Complications / Q000139:chemically induced* / Q000175:diagnosis / Q000628:therapy; D011654:Pulmonary Edema / Q000000981:diagnostic imaging / Q000209:etiology; D011859:Radiography
chemical_list: D000701:Analgesics, Opioid; D001993:Bronchodilator Agents; D005283:Fentanyl; D004837:Epinephrine