title: [A case of asystole following povidone iodine administration].
abstract: We present a case of asystole due to anaphylactoid reaction after vaginal disinfection with povidone iodine under epidural anesthesia combined with general anesthesia. A 71-year-old woman was scheduled to undergo total cystectomy due to vesical cancer, invading into the wall of the vagina. After induction of anesthesia, epidural injection with 10 ml of 1% lidocaine and cleansing the vagina with povidone iodine solution were done at the same time. Shortly thereafter, sudden hypotension and bradycardia and asystole occurred. Multiple doses of epinephrine, chest compression, transcutaneous pacing and defibrillation were required to restore her spontaneous circulation. The surgery was cancelled. She stayed a night at the intensive care unit, and was discharged without any neurological complications the next day. The serum concentration of histamine increased to 7.0 microg x l(-1), but that of tryptase was within normal ranges when spontaneous circulation returned. The serum concentration of total iodine increased to 57.9 microg x dl(-1), which did not reach the toxic level. These results suggest that the circulatory collapse was probably caused by anaphylactoid reaction to povidone iodine. Epidural anesthesia may have worsened the circulatory collapse.
authors.affiliation: Department of Anesthesiology, Hirosaki University School of Medicine Hospital, Hirosaki 036-8562.
authors.forename: Tomoko
authors.initials: T
authors.lastname: Ono
authors.forename: Tetsuya
authors.initials: T
authors.lastname: Kushikata
authors.forename: Toshihito
authors.initials: T
authors.lastname: Tsubo
authors.forename: Hironori
authors.initials: H
authors.lastname: Ishihara
authors.forename: Kazuyoshi
authors.initials: K
authors.lastname: Hirota
mesh_terms: D000368:Aged; D000707:Anaphylaxis / Q000209:etiology*; D000767:Anesthesia, Epidural; D000768:Anesthesia, General; D000891:Anti-Infective Agents, Local / Q000009:adverse effects*; D015653:Cystectomy; D005260:Female; D006323:Heart Arrest / Q000139:chemically induced*; D006801:Humans; D011206:Povidone-Iodine / Q000009:adverse effects*; D001749:Urinary Bladder Neoplasms / Q000601:surgery
chemical_list: D000891:Anti-Infective Agents, Local; D011206:Povidone-Iodine