Fentanyl-associated anaphylaxis in an infant with tetralogy of Fallot: a case report.

BACKGROUND: Anaphylactic reactions to opioids are rare. We report a case of an infant who experienced fentanyl-induced anaphylaxis. CASE PRESENTATION: A 2-month-old male was scheduled to undergo a Blalock-Taussig shunt. Following uneventful anesthetic induction, he experienced profound hypotension and generalized erythema. Anaphylaxis was clinically diagnosed, and he was treated with epinephrine, vasopressin, and fluids. The surgery was canceled, and he was transferred to the intensive care unit after restoration of his hemodynamic status. Intradermal testing was performed for all of the drugs given during the anaphylactic event on postoperative day (POD) 3. The results showed a positive reaction to fentanyl. For the second anesthesia scheduled on POD 5, morphine sulfate was selected as an alternative opioid. Anesthesia was maintained uneventfully with sevoflurane, morphine, and rocuronium. CONCLUSION: Intradermal testing revealed fentanyl anaphylaxis. We were able to manage the patient by using of morphine as an alternative opioid for the subsequent anesthesia.

[Anesthetic Management of a Patient who Developed Intraoperative Paroxysmal Supraventricular Tachycardia with Pulseless Electric Activity].

A 75-year-old woman was scheduled to undergo an ileus operation under general combined with epidural anesthesia. Preoperative electrocardiogram (ECG) showed first-degree atrioventricular block. The patient received no preoperative antiarrhythmic medication. During surgery, paroxysmal supraventricular tachycardia (PSVT) occurred unexpectedly with radial artery pulsation disappearing, indicating pulseless electric activity (PEA). After a five-second episode of PSVT, her sinus rhythm recovered spontaneously. However, the patient had repeated short duration of PSVT with PEA. Continuous infusion of ultra-short-acting ß-blocker landiolol successfully terminated the PSVT, and sinus rhythm was restored. Postoperative ECG showed sinus rhythm. This case report indicates that ß-blocker can be a drug of choice in patients with PSVT associated with PEA.

[Usefulness of the guidelines for prevention of perioperative anaphylaxis associated with latex allergy].

BACKGROUND: Anaphylaxis associated with latex allergy is one of the fatal complications during anesthesia. To prevent this complication, we find out latex allergy and high-risk patients by preoperative interview and keep away not only latex allergic patients but high-risk patients from latex allergen in the operating room. In this study, we evaluated the cost-benefit efficiency of our guidelines. METHODS: This is a prospective observational study for six month. We classified the patients undergoing elective operation into three categories: latex allergy (group LA), high-risk of latex allergy (group LH) and control (group C), and we compared the incidence of perioperative anaphylaxis and the cost of using products without latex allergen. RESULTS: A total of 1.291 patients were enrolled in the analysis. Five patients (0.4%) and 206 patients (16.0%) categorized into group LA, and LH respectively. There was no patient diagnosed with anaphylaxis associated with latex allergy during the observation period. We are able to save the cost of 3.5 million yen every year by our method than using products without latex allergen for all cases. CONCLUSIONS: Our guidelines for prevention of perioperative anaphylaxis associated with latex allergy might be efficient from the standpoint of cost-benefit

[Spinal anesthesia using a low dose of isobaric bupivacaine in a patient with pulmonary artery hypertension and mixed obstructive and restrictive lung disease undergoing repeated femoral fracture surgery].

A 75-year-old woman with primary pulmonary hypertension was on medical therapy and ambulatory oxygen inhalation therapy for 7 years. The patient had right femoral fracture and was admitted to our hospital. She had also suffered from asthma for 2 years, and her vital capacity was 1.35 l with forced expiratory volume in 1 second 0.79 l, and with her mean pulmonary artery pressure 60 mmHg. Open reduction and internal fixation were performed under spinal anesthesia using isobaric bupivacaine 6 mg with fentanyl 10 microg, and the patient was discharged on postoperative 31 day with no major complications. One year after the surgery, she had left femoral fracture, and surgery was performed under spinal anesthesia using isobaric bupivacaine 6 mg with fentanyl 10 microg. With its minimal effects on hemodynamics, we speculate that spinal anesthesia using a low dose of isobaric bupivacaine can be a choice for patients with pulmonary hypertension.