title: Intraoperative Anaphylactic Reaction: Is it the Floseal?
abstract: When hemodynamic or respiratory instability occurs intraoperatively, the inciting event must be determined so that a therapeutic plan can be provided to ensure patient safety. Although generally uncommon, one cause of cardiorespiratory instability is anaphylactic reactions. During anesthetic care, these most commonly involve neuromuscular blocking agents, antibiotics, or latex. Floseal is a topical hemostatic agent that is frequently used during orthopedic surgical procedures to augment local coagulation function and limit intraoperative blood loss. As these products are derived from human thrombin, animal collagen, and animal gelatin, allergic phenomenon may occur following their administration. We present 2 pediatric patients undergoing posterior spinal fusion who developed intraoperative hemodynamic and respiratory instability following use of the topical hemostatic agent, Floseal. Previous reports of such reactions are reviewed, and the perioperative care of patients with intraoperative anaphylaxis is discussed.
authors.affiliation: Department of Anesthesiology & Pain Medicine, Nationwide Children's Hospital, Columbus, Ohio.
authors.forename: Brianne
authors.initials: B
authors.lastname: Bordes
authors.affiliation: Department of Anesthesiology & Pain Medicine, Nationwide Children's Hospital, Columbus, Ohio ; Department of Anesthesiology & Pain Medicine, The Ohio State University College of Medicine, Columbus, Ohio.
authors.forename: David
authors.initials: D
authors.lastname: Martin
authors.affiliation: Department of Anesthesiology & Pain Medicine, Nationwide Children's Hospital, Columbus, Ohio ; Department of Anesthesiology & Pain Medicine, The Ohio State University College of Medicine, Columbus, Ohio.
authors.forename: Brian
authors.initials: B
authors.lastname: Schloss
authors.affiliation: Department of Orthopedic Surgery, Nationwide Children's Hospital and the Ohio State University, Columbus, Ohio.
authors.forename: Allan
authors.initials: A
authors.lastname: Beebe
authors.affiliation: Department of Orthopedic Surgery, Nationwide Children's Hospital and the Ohio State University, Columbus, Ohio.
authors.forename: Walter
authors.initials: W
authors.lastname: Samora
authors.affiliation: Department of Orthopedic Surgery, Nationwide Children's Hospital and the Ohio State University, Columbus, Ohio.
authors.forename: Jan
authors.initials: J
authors.lastname: Klamar
authors.affiliation: Department of Pediatrics, Nationwide Children's Hospital and The Ohio State University College of Medicine, Columbus, Ohio.
authors.forename: David
authors.initials: D
authors.lastname: Stukus
authors.affiliation: Department of Anesthesiology & Pain Medicine, Nationwide Children's Hospital, Columbus, Ohio ; Department of Anesthesiology & Pain Medicine, The Ohio State University College of Medicine, Columbus, Ohio ; Department of Pediatrics, Nationwide Children's Hospital and The Ohio State University College of Medicine, Columbus, Ohio.
authors.forename: Joseph D
authors.initials: JD
authors.lastname: Tobias
keywords: Floseal; adverse drug reaction; anaphylaxis; coagulation; hemostatic agent; topical