Allergic reaction to patent blue dye in breast surgery - case report / Reação alérgica ao corante azul patente em cirurgia de mama - relato de caso

Abstract We present a case of allergic reaction to patent blue in a patient who underwent excision of sentinel lymph node associated with segmental breast resection. About 20 min after the dye injection, the patient developed hypotension (BP = 70 × 30 mmHg) associated with increased heart frequency. The patient was treated successfully with decreased inspired fraction of inhaled anesthetic and fluid replacement. At the end of the procedure, she presented with bluish urticarial-like plaques on the head, neck, upper limbs, and trunk; hydrocortisone was then used. The patient recovered uneventfully and was discharged from the PACU 2 h after the end of surgery without skin changes, and was discharged from hospital on the morning after surgery. The incidence of allergic reactions with the use of patent blue is far superior to the hypersensitivity reactions seen with anesthetic and adjuvant drugs. Therefore, the anesthesiologist must be aware of cardiovascular instability associated with skin changes during the use of patent blue, for early diagnosis and appropriate treatment of this hypersensitivity reaction to this dye.

Resumo Os autores apresentam um caso de reação alérgica ao azul patente em uma paciente submetida à exérese de linfonodo em sentinela associada a uma ressecção segmentar de mama. Paciente apresentou aproximadamente pós 20 minutos da injeção do corante hipotensão (PA = 70 × 30 mmHg) associada a aumento da frequência cardíaca. Foi tratada satisfatoriamente com diminuição da fração inspirada do anestésico inalatório e reposição volêmica. No fim do procedimento apresentava placas urticariformes azuladas em cabeça, pescoço, membros superiores e tronco e foi usada hidrocortisona. Evoluiu, sem intercorrências, na sala de recuperação pós-anestésica e teve alta duas horas após o término do procedimento cirúrgico sem a presença das alterações cutâneas. Alta hospitalar na manhã seguinte à cirurgia. A incidência de reações alérgicas com o emprego do azul patente é muito superior às reações de hipersensibilidade observadas com drogas anestésicas e adjuvantes. Portanto, o anestesiologista deve ficar atento à instabilidade cardiovascular associada a alterações cutâneas quando do uso do azul patente para o diagnóstico precoce e tratamento adequado dessa reação de hipersensibilidade com o emprego do corante.

Allergic reaction to patent blue dye in breast surgery - case report.

We present a case of allergic reaction to patent blue in a patient who underwent excision of sentinel lymph node associated with segmental breast resection. About 20min after the dye injection, the patient developed hypotension (BP=70×30mmHg) associated with increased heart frequency. The patient was treated successfully with decreased inspired fraction of inhaled anesthetic and fluid replacement. At the end of the procedure, she presented with bluish urticarial-like plaques on the head, neck, upper limbs, and trunk; hydrocortisone was then used. The patient recovered uneventfully and was discharged from the PACU 2h after the end of surgery without skin changes, and was discharged from hospital on the morning after surgery. The incidence of allergic reactions with the use of patent blue is far superior to the hypersensitivity reactions seen with anesthetic and adjuvant drugs. Therefore, the anesthesiologist must be aware of cardiovascular instability associated with skin changes during the use of patent blue, for early diagnosis and appropriate treatment of this hypersensitivity reaction to this dye.

[Allergic reaction to patent blue dye in breast surgery - case report]. / Reação alérgica ao corante azul patente em cirurgia de mama - relato de caso.

We present a case of allergic reaction to patent blue in a patient who underwent excision of sentinel lymph node associated with segmental breast resection. About 20minutes after the dye injection, the patient developed hypotension (BP=70×30mmHg) associated with increased heart frequency. The patient was treated successfully with decreased inspired fraction of inhaled anesthetic and fluid replacement. At the end of the procedure, she presented with bluish urticarial - like plaques on the head, neck, upper limbs, and trunk; hydrocortisone was then used. The patient recovered uneventfully and was discharged from the PACU two hours after the end of surgery without skin changes, and was discharged from hospital on the morning after surgery. The incidence of allergic reactions with the use of patent blue is far superior to the hypersensitivity reactions seen with anesthetic and adjuvant drugs. Therefore, the anesthesiologist must be aware of cardiovascular instability associated with skin changes during the use of patent blue, for early diagnosis and appropriate treatment of this hypersensitivity reaction to this dye.

Desafios para a implementação do Programa de Planejamento Familiar em uma comunidade de baixa renda em Aracaju (Sergipe), Brasil / Challenges for the implementation of the Family Planning Program in a low-income community in aracaju, Sergipe, Brazil

Um estudo das características reprodutivas e do significado do planejamento familiar para mulheres em idade fértil e para a equipe de saúde que as assiste foi realizado em uma comunidade de baixa renda em Aracaju (SE). Na etapa descritiva, foram aplicados questionários estruturados a 90 usuárias de uma Unidade Básica de Saúde, por sorteio aleatório das pastas-família, contendo dados pessoais e da vida reprodutiva. Esta etapa foi seguida de uma abordagem qualitativa, na qual foram realizados grupos focais com seis usuárias e com a equipe de saúde, utilizando questionários semi-estruturados para avaliar a prática de planejamento familiar. As mulheres mostraram que conhecimento e oferta de métodos anticoncepcionais não garantem um planejamento familiar adequado. Mais de 97% das participantes referiram conhecer a camisinha, a pílula e o injetável, e 73,6% das sexualmente ativas praticam anticoncepção, mas 76% daquelas que já engravidaram referiram uma ou mais gestações não-planejadas. Nos grupos focais, outras abordagens do planejamento familiar, como assistência à pré-concepção, acesso ao homem e educação em saúde, mostraram que precisam ser trabalhadas pela equipe para que as usuárias programem melhor sua prole.

A study on the reproductive characteristics and the meaning of family planning for childbearing age women and for the health team providing care to them was conducted in a low-income community in Aracaju - SE. In the descriptive stage of the study structured questionnaires were applied to 90 users of a Primary Care Unit random-selected from the family files containing personal data and information about the reproductive life of the women. This stage was followed by a qualitative approach in focal groups with six users and the health team applying semi-structured questionnaires for assessing the practice of family planning. The study showed that knowledge and offer of contraceptive methods are no guarantee of proper family planning. More than 97% of the participants related knowing about the condom, the pill and the contraceptive injection. 73,6% of the sexually active women practiced contraception but 76% of those who already had had a pregnancy referred to one or more unintended gestations. The focal groups revealed the need for other approaches to family planning such as preconception care, access to the partners and education in health to be developed by the team in order to help the users to better plan their offspring.