Kosin Med J.  2018 Dec;33(2):245-251. 10.7180/kmj.2018.33.2.245.

Anaphylaxis occurred immediately after prophylactic antibiotics injection with negative intradermal skin test during laparoscopic cholecystectomy

• Jeong HJ
• Kung HC
• Park TW
• Kang DH
• Shin YS
• Kim JD

• KMID: 2430742
• DOI: http://doi.org/10.7180/kmj.2018.33.2.245

Abstract

Prophylactic antibiotics that are used to prevent post-operative infection can commonly cause anaphylactic reactions during anesthesia. It is therefore necessary to perform a skin test before antibiotics are administered in order to diagnose and prevent anaphylactic reactions. However, the results of the antibiotic skin test can differ according to the drug, dose, and reagent concentration. We report a case of anaphylactic shock with bronchospasm and cardiovascular collapse immediately following administration of the prophylactic cefazedone after induction of general anesthesia for laparoscopic cholecystectomy.

Keyword

Anaphylaxis; Antibiotics; Intradermal tests; Shock

MeSH Terms

Anaphylaxis*
Anesthesia
Anesthesia, General
Anti-Bacterial Agents*
Bronchial Spasm
Cholecystectomy, Laparoscopic*
Intradermal Tests
Shock
Skin Tests*
Skin*
Anti-Bacterial Agents

Figure

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  Fig. 1 Graph of vital signs after induction of anesthesia. After refosporen (cefazedone sodium) administration, a sudden increase in heart rate, decrease in blood pressure, and desaturation were observed. After aggressive treatment with 2 administrations of epinephrine 0.2 mg, the patient's hemodynamics stabilized to some extent, and the operation could be completed.

Reference

1. Dewachter P, Mouton-Faivre C, Emala CW. Anaphylaxis and anesthesia: controversies and new insights. Anesthesiology. 2009; 111:1141–1150.

2. Kroigaard M, Garvey LH, Gillberg L, Johansson SG, Mosbech H, Florvaag E, et al. Scandinavian Clinical Practice Guidelines on the diagnosis, management and follow-up of anaphylaxis during anaesthesia. Acta Anaesthesiol Scand. 2007; 51:655–670.

3. Torres MJ, Romano A, Mayorga C, Moya MC, Guzman AE, Reche M, et al. Diagnostic evaluation of a large group of patients with immediate allergy to penicillins: the role of skin testing. Allergy. 2001; 56:850–856.

4. Brockow K, Romano A, Blanca M, Ring J, Pichler W, Demoly P. General considerations for skin test procedures in the diagnosis of drug hypersensitivity. Allergy. 2002; 57:45–51.

5. Classen DC, Evans RS, Pestotnik SL, Horn SD, Menlove RL, Burke JP. The timing of prophylactic administration of antibiotics and the risk of surgical-wound infection. N Engl J Med. 1992; 326:281–286.

6. Harper NJ, Dixon T, Dugué P, Edgar DM, Fay A, Gooi HC, et al. Suspected anaphylactic reactions associated with anaesthesia. Anaesthesia. 2009; 64:199–211.

7. Park JE, Hwang SY, Lee YS, Lee HK, Lee YM. Analysis on Results of Cephalosporin Skin Testing and Developments of Hypersensitivity Reactions. J Korean Soc Health Syst Pharm. 2013; 30:343–361.

8. Kim KN, Kim DW, Sin YH, Oh SY. Anaphylactic shock caused by an intradermal skin test-negative antibiotic during general anesthesia : A case report. Anesth Pain Med. 2016; 11:260–263.

9. Trautmann A, Seidl C, Stoevesandt J, Seitz CS. General anaesthesia-induced anaphylaxis: impact of allergy testing on subsequent anaesthesia. Clin Exp Allergy. 2016; 46:125–132.

10. Moreno E, Macías E, Dávila I, Laffond E, Ruiz A, Lorente F. Hypersensitivity reactions to cephalosporins. Expert Opin Drug Saf. 2008; 7:295–304.

11. Torres MJ, Blanca M, Fernandez J, Romano A, Weck A, Aberer W, et al. Diagnosis of immediate allergic reactions to beta-lactam antibiotics. Allergy. 2003; 58:961–972.

12. Ebo DG, Fisher MM, Hagendorens MM, Bridts CH, Stevens WJ. Anaphylaxis during anaesthesia: diagnostic approach. Allergy. 2007; 62:471–487.

13. Mertes PM, Malinovsky JM, Jouffroy L, Aberer W, Terreehorst I, Brockow K, et al. Reducing the risk of anaphylaxis during anesthesia: 2011 updated guidelines for clinical practice. J Investig Allergol Clin Immunol. 2011; 21:442–453.

14. Woods BD, Sladen RN. Perioperative considerations for the patient with asthma and bronchospasm. Br J Anaesth. 2009; 103:i57–i65.

15. Dewachter P, Mouton-Faivre C, Emala CW, Beloucif S. Case scenario: bronchospasm during anesthetic induction. Anesthesiology. 2011; 114:1200–1210.