Lohsiriwat Varut, Sriyoscharti Somchai, Raksakietisak Manee, Leelarasamee Amorn
Department of Surgery, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand.
J Med Assoc Thai. 2012 Jun;95(6):825-9.
Cephalosporin anaphylaxis is rare but the diagnosis is usually not delayed when the catastrophic reaction occurs shortly after cephalosporin injection. The authors wish to report a patient who had never had a history of beta-lactam hypersensitivity and developed the first episode of cefazolin anaphylaxis during coronary artery bypass surgery. Hypotension developed during the operation but it was immediately corrected by volume infusion and inotrope administration. Shaking chills, drenching sweats, and tingling sensation on the head developed when she regained consciousness from general anesthesia. The adverse reaction disappeared soon and was thought to be the side effects of anesthetic drugs, morphine administrations, and/or blood transfusion. Similar reactions, together with hypotension and oxygen desaturation, recurred each time cefazolin was infused but it took three days and doses of 12 grams of cefazolin administration before a correct diagnosis was reached. The present case report would remind surgeons and anesthesiologists of cefazolin as a potential cause of anaphylaxis during peri- and post-operative periods.
头孢菌素过敏反应很少见，但如果在注射头孢菌素后不久发生严重反应，通常不会延迟诊断。作者希望报告一例患者，该患者既往无β-内酰胺类药物过敏史，在冠状动脉搭桥手术期间首次发生头孢唑林过敏反应。手术过程中出现低血压，但通过补液和使用血管活性药物立即得到纠正。当她从全身麻醉中苏醒时，出现寒战、大汗淋漓和头部刺痛感。不良反应很快消失，被认为是麻醉药物、吗啡给药和/或输血的副作用。每次输注头孢唑林时，类似反应以及低血压和氧饱和度下降都会再次出现，但在输注12克头孢唑林、历时三天后才做出正确诊断。本病例报告将提醒外科医生和麻醉医生，头孢唑林是围手术期和术后过敏反应的潜在原因。
