Culp Jeffrey A, Palis Ross I, Castells Mariana C, Lucas Sean R, Borish Larry
Asthma and Allergic Disease Center, University of Virginia Health System, Charlottesville, VA 22908, USA.
Allergy Asthma Proc. 2007 Sep-Oct;28(5):602-5. doi: 10.2500/aap2007.28.3047.
This article presents a case report of perioperative anaphylaxis in a previously nonallergic 44-year-old man undergoing cervical spine surgery. After receiving general anesthesia with midazolam, propofol, lidocaine, fentanyl, rocuronium, and sevoflurane and cefazolin for prophylaxis, the patient developed hypotension, tachycardia, bronchospasm, and generalized erythema. A serum tryptase concentration was markedly elevated 2 hours after the anaphylactic episode. Initial prick and intradermal skin tests (excluding skin testing for unavailable benzylpenicilloyl polylysine) and IgE immunoassays for penicillin and cefazolin were negative. However, repeat prick skin testing for cefazolin 6 weeks after anaphylaxis was positive. Although anaphylaxis to cephalosporins is rare, it remains a potential cause of perioperative anaphylaxis. All cases of perioperative anaphylaxis require a workup to identify the offending agent and to avoid future reactions. Skin testing regimens for several commonly implicated drugs used for general anesthesia are available and are described.
本文介绍了一例 44 岁既往无过敏史的男性在接受颈椎手术时发生围手术期过敏反应的病例报告。患者在接受咪达唑仑、丙泊酚、利多卡因、芬太尼、罗库溴铵和七氟醚全身麻醉并预防性使用头孢唑林后，出现低血压、心动过速、支气管痉挛和全身红斑。过敏反应发作 2 小时后血清类胰蛋白酶浓度显著升高。最初的点刺和皮内皮肤试验（不包括对无法获得的苄青霉素酰聚赖氨酸进行皮肤试验）以及针对青霉素和头孢唑林的 IgE 免疫测定均为阴性。然而，过敏反应 6 周后重复进行的头孢唑林点刺皮肤试验呈阳性。虽然对头孢菌素的过敏反应很少见，但它仍然是围手术期过敏反应的一个潜在原因。所有围手术期过敏反应病例都需要进行检查以确定致病因素并避免未来的反应。文中提供并描述了几种常用于全身麻醉的常见相关药物的皮肤试验方案。
