Anesthetic Management in a Patient with Anaphylaxis to Thiopental: A case report / 대한마취과학회지

ABSTRACT

The incidence of anaphylaxis to intravenous agents used for general anaesthesia is reported as about 1 6000. Despite appropriate treatment, mortality is reported as about 6%, thus it is important to try to minimize the risk by prevention. A adequate investigation, communication and avoidance of drugs responsible with the use of pretreatment and alternative techniques, the risk of second reaction should be reduced. A patient who has the history of anaphylactic shock to thiopental, for the induction of anesthesia was scheduled for subtotal gastrectomy. Skin test confirmed that she had a hypersensitivity to a thiopental. We performed combined general and spinal anesthesia. She was premedicated with dexamethasone and pheniramine malate in the operating room. Spinal blockade is up to T6 by 0.5% tetracaine. Then, anesthesia was induced with propofol and midazolam. There is no need for muscle relaxant drugs and anesthesia was maintained with isoflurane, N2O, O2. Subtotal gastrectomy was done without event. Combined general and spinal anesthesia affords the anesthesiologist the opportunity to lower the local anesthetic doses, to avoid using many kinds of intravenous drugs (muscle relaxants, opioids, benzodiazepine, etc.) and to approach a kind of anesthesia that is close to the ideal anesthesia.