Kounis syndrome during general anaesthesia and administration of adrenaline

Abstract

During the course of anaphylaxis, occurrence of myocardial ischaemia has been known, which have recently been named as Kounis syndrome [ [1] Kounis N.G. Kounis syndrome (allergic angina and allergic myocardial infarction): a natural paradigm?. Int J Cardiol. 2006; 110: 7-14 Abstract Full Text Full Text PDF PubMed Scopus (387) Google Scholar ]. Regarding treatment for this syndrome, early intravenous administration of adrenaline is the key points for managing anaphylaxis [ 2 Dawachter P. Mouton-Faivre C. Emala C.W. Anaphylaxis and anesthesia. Controversies and new insights.. Anesthesiology. 2009; 111: 1141-1150 Crossref PubMed Scopus (236) Google Scholar , 3 Kroigaard M. Garvey L.H. Gillberg L. et al. Scandinavian Clinical Practice Guidelines on the diagnosis, management and follow-up of anaphylaxis during anaesthesia. Acta Anaesthesiol Scand. 2007; 51: 655-670 Crossref PubMed Scopus (210) Google Scholar , 4 Lieberman P. Kemp S.F. Oppenheimer J. et al. The diagnosis and management of anaphylaxis: an updated practice parameter. J Allergy Clin Immunol. 2005; 115: S483-S523 Abstract Full Text Full Text PDF PubMed Scopus (520) Google Scholar ] but adrenaline can aggravate myocardial ischaemia. Moreover, whether adrenaline is effective or not is controversial [ 5 Cevik C. Nugent K. Shome G.P. Kounis N.G. Treatment of Kounis syndrome. Int J Cardiol. 2010; 143: 223-226 Abstract Full Text Full Text PDF PubMed Scopus (101) Google Scholar , 6 Ridella M. Bagdure S. Nugent K. Cevik C. Kounis syndrome following beta-lactam antibiotic use: review of literature. Inflamm Allergy Drug Targets. 2009; 8: 11-16 Crossref PubMed Scopus (54) Google Scholar ]. We report a case of Kounis syndrome during general anaesthesia in which administration of adrenaline was effective in both anaphylactic shock and myocardial ischaemia, and discuss perioperative problems about diagnosis and therapy.