Suzuki Manzo, Kawase Hajime, Ogita Azusa, Bito Hiroyasu
Anesthesiologist, Yatsu Health Hospital, Chiba, Japan.
Department of Anesthesiology, Musashikosugi Hospital Nippon Medical School, Kawasaki, Kanagawa, Japan.
Case Rep Anesthesiol. 2020 Jan 28;2020:8163620. doi: 10.1155/2020/8163620. eCollection 2020.
Among patients who develop anaphylaxis during anesthesia, anaphylaxis caused by a neuromuscular blocking agent has the highest incidence. In patients who developed IgE-mediated anaphylaxis, and cross-reactivity among NMBAs is a concern in subsequent anesthetic procedures. We present a patient who developed rocuronium-induced anaphylaxis in whom the skin prick test (SPT) and intradermal test (IDT) could identify a safe drug to use in the subsequent anesthetic procedure. A 32-year-old female developed anaphylactic shock at the induction of general anesthesia. She recovered by administration of hydrocortisone and epinephrine. Skin tests including the SPT followed by the IDT revealed rocuronium as the drug that caused anaphylaxis and vecuronium as a safe drug to use for the subsequent general anesthesia. She safely underwent surgery with general anesthesia using vecuronium one month after the skin testing. There are not many reports on the effectiveness of the SPT followed by IDT in identifying the causative drug as well as a safe drug to use in the subsequent anesthetic procedure following anaphylaxis during anesthesia. The usefulness of the SPT should be re-evaluated.
在麻醉期间发生过敏反应的患者中，由神经肌肉阻滞剂引起的过敏反应发生率最高。在发生IgE介导的过敏反应的患者中，神经肌肉阻滞剂之间的交叉反应性是后续麻醉过程中需要关注的问题。我们报告了一名发生罗库溴铵诱导的过敏反应的患者，其皮肤点刺试验（SPT）和皮内试验（IDT）能够确定在后续麻醉过程中可安全使用的药物。一名32岁女性在全身麻醉诱导时发生过敏性休克。通过给予氢化可的松和肾上腺素后康复。包括SPT随后进行IDT的皮肤试验显示，罗库溴铵是引起过敏反应的药物，维库溴铵是后续全身麻醉可安全使用的药物。皮肤试验一个月后，她使用维库溴铵安全地接受了全身麻醉手术。关于SPT随后进行IDT在确定致病药物以及在麻醉期间发生过敏反应后的后续麻醉过程中可安全使用的药物方面的有效性，报道并不多。应重新评估SPT的实用性。
