title: [Case of aprotinin-induced anaphylactic shock].
abstract: We report a case of anaphylactic shock caused by repeated use of aprotinin. Following re-administration of aprotinin at the beginning of repeated mitral valve replacement, the patient fell into shock state probably induced by anaphylactic reactions. Immediately, bispectral index (BIS) decreased from 40 to 5, and near-infrared spectroscopy showed regional tissue oxygen saturation (rSO2) of frontal head decreasing from 64/56% (left/right) to 26/36%. Despite massive use of inotropes, the blood pressure, BIS and frontal rSO2 were not improved. After the immediate initiation of cardiopulmonary bypass, the perfusion pressure increased to 40 mmHg, and BIS and frontal rSO2 recovered to 45 and 70/61%, respectively. The patient had no significant neurological sequela after the surgery. We conclude that parallel changes of BIS and frontal rSO2 reflect acute global cerebral ischemia, and these parameters may be useful for decision making in the treatment of shock patients.
authors.affiliation: Department of Anesthesia, Kyoto University Hospital, Kyoto 606-8507.
authors.forename: Yuko
authors.initials: Y
authors.lastname: Fujiwara
authors.forename: Shogo
authors.initials: S
authors.lastname: Matsuura
authors.forename: Kazuhiko
authors.initials: K
authors.lastname: Fukuda
mesh_terms: D000368:Aged; D000707:Anaphylaxis / Q000139:chemically induced* / Q000175:diagnosis / Q000628:therapy; D000758:Anesthesia; D007611:Aprotinin / Q000008:administration & dosage / Q000009:adverse effects*; D002545:Brain Ischemia / Q000139:chemically induced / Q000175:diagnosis / Q000628:therapy; D002395:Catecholamines / Q000627:therapeutic use; D005260:Female; D019918:Heart Valve Prosthesis Implantation; D006801:Humans; D007423:Intra-Aortic Balloon Pumping; D007430:Intraoperative Care; D007431:Intraoperative Complications / Q000139:chemically induced* / Q000628:therapy; D008943:Mitral Valve / Q000601:surgery; D016343:Monitoring, Intraoperative; D012086:Reoperation; D019265:Spectroscopy, Near-Infrared; D016896:Treatment Outcome
chemical_list: D002395:Catecholamines; D007611:Aprotinin