Propofol-induced anaphylactoid reaction during anesthesia for cardiac surgery

Abstract

A 51-year-old man with a history of unstable angina was scheduled for CABG surgery. He had no history of a prior general anesthetic or allergies. He sustained a Q-wave inferior myocardial infarction 12 years ago, and his ejection fraction was 54%. Current medications were nisoldipine, 5 mg, a calcium channel blocker; celiprolol, 200 mg, a P-blocker; and md the peak inspiratory pressures were normal. Intravenous epinephrine was administered at a dose of 200 pg, repeated 1 minute later, and followed by a continuous infusion at a rate of 0.2 pg/kg/min. The propofol infdsion was then stopped. In addition, hemodynamic stabilization required volume loading with crystalloids and the percutaneous placement of an intraaortic balloon pump. Isoflurane was gradually introduced with midazolam and a continuous infusion of morphine to replace the anesthetic drugs used during the induction. As the hemodynamics improved, epinephrine was progressively reduced and discontinued over 90 minutes. The surgical procedure was uneventful. Weaning hrn cardiopulmonary bypass was possible without inotropes. Extubation was performed 8 hours