Assem E S, Ling Y B
Department of Pharmacology, University College London.
Anaesthesia. 1988 Nov;43(11):958-61. doi: 10.1111/j.1365-2044.1988.tb05662.x.
A 40-year-old woman suffered cardiovascular collapse, cardiac ischaemia and arrest during induction of anaesthesia. Severe cerebral ischaemic damage was sustained during this episode and the patient died 4 days later. This fatal reaction was shown to be anaphylactic in origin; the causative agent was suxamethonium. High levels of IgE antibodies specific to the quaternary ammonium group (two of which are present in suxamethonium) were detected by the radioallergosorbent test. Results of the leucocyte histamine release test were less clear, partly as a result of steroid treatment. The two most relevant points were the absence of a history of previous anaesthesia, and involvement of the heart as the principal target of the reaction. This unfortunate and extreme case indicates the necessity for allergy testing (screening) before anaesthesia, and the need for organisation and funding of this procedure, if these fatal or near-fatal reactions are to be prevented. It is a timely reminder that action should be taken, since neuromuscular blockers have been confirmed as the most common culprits, and that specific tests for IgE antibodies are now available against haptenic groups generally common to all neuromuscular blockers.
一名40岁女性在麻醉诱导期间发生心血管虚脱、心肌缺血和心脏骤停。在此期间发生了严重的脑缺血性损伤，患者于4天后死亡。结果显示，这种致命反应源于过敏反应；致病药物为琥珀胆碱。通过放射变应原吸附试验检测到针对季铵基团（琥珀胆碱中含有两个季铵基团）的高水平IgE抗体。白细胞组胺释放试验的结果不太明确，部分原因是使用了类固醇治疗。两个最相关的要点是患者既往无麻醉史，以及心脏是该反应的主要靶器官。这一不幸的极端病例表明，为预防这些致命或近乎致命的反应，麻醉前进行过敏检测（筛查）很有必要，且需要为此程序进行组织和提供资金。这适时地提醒人们应采取行动，因为神经肌肉阻滞剂已被确认为最常见的罪魁祸首，而且现在已有针对所有神经肌肉阻滞剂普遍共有的半抗原基团的IgE抗体特异性检测方法。
