Abstract
IntroductionThe incidence of anaphylactic reactions during anesthesia is between 1:5000 and 1:25000 and it is one of the few causes of mortality directly related to general anesthesia. The most important requirements in the treatment of this clinical condition are early diagnosis and maintenance of vital organ perfusion. Epinephrine administration is generally considered as the first line treatment of anaphylactic reactions. However, recently, new pharmacological approaches have been described in the treatment of different forms of vasoplegic shock.Case presentationWe describe the case of a child who was undergoing surgery for ventricular septal defect, with an anaphylactic reaction to heparin that was refractory to epinephrine infusion and was effectively treated by low dose vasopressin infusion.ConclusionIn case of anaphylactic shock, continuous infusion of low-dose vasopressin might be considered after inadequate response to epinephrine, fluid resuscitation and corticosteroid administration.
Highlights
The incidence of anaphylactic reactions during anesthesia is between 1:5000 and 1:25000 and it is one of the few causes of mortality directly related to general anesthesia [1]
Epinephrine administration is generally considered as the first line treatment of anaphylactic reactions [1]
We describe a case in which low dose vasopressin promply reestablished hemodynamic stability in a vasoplegic state due to an anaphylactic reaction that was refractory to epinephrine infusion
Summary
The incidence of anaphylactic reactions during anesthesia is between 1:5000 and 1:25000 and it is one of the few causes of mortality directly related to general anesthesia [1]. Epinephrine infusion was started at a dose to 0.1 mcg/kg/ min in order to achieve a perfusion pressure of 40 mmHg. Metabolic acidosis progressively improved (pH = 7.38) with an initial reduction in plasma lactate levels (5.1 mmol/L). When vital parameters seemed adequately stable, the surgical procedure was performed with a CPB time of 25 minutes During this time, the epinephrine infusion could not be stopped and the first weaning from CPB failed because of severe hypotension (mean SAP = 30 mmHg) despite epinephrine administration being titrated up to 0.3 mcg/kg/min. Epinephrine infusion was immediately reduced to 0.05 mcg/kg/min and the patient was successfully weaned from CPB with stable hemodynamic parameters. No adverse effects due to the vasopressin administration were reported
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