两名患者在麻醉诱导后发生危及生命的过敏反应，对预防性使用的抗生素和罗库溴铵的皮肤试验均呈阳性。
Concurrent positive skin tests to prophylactic antibiotics and rocuronium in two patients with life-threatening anaphylaxis after induction of anesthesia.
作者信息
Yasuda Masako, Moriwaki Katsuyuki, Tsutsumi Yasuo M
机构信息
Department of Anesthesiology, Critical Care and Pain Medicine, National Hospital Organization Kure-Medical Center Chugoku Cancer Center, 3-1 Aoyamacho, Kure, Hiroshima, 737-0023, Japan.
Department of Anesthesiology, Hiroshima Hiramatsu Hospital, 11-27 Hijiyama Honmachi, Minami-ku, Hiroshima, 732-0816, Japan.
出版信息
JA Clin Rep. 2021 Apr 20;7(1):37. doi: 10.1186/s40981-021-00440-0.
BACKGROUND
Prophylactic antibiotics and neuromuscular blocking agents (NMBA) are two of the major causative agents of anaphylaxis after induction of anesthesia.
CASE PRESENTATION
One female and one male patients (aged 29 and 69 years, respectively) had Ring and Messmer scale grade III anaphylaxis after administration of prophylactic antibiotics following induction of anesthesia. They showed typical hemodynamic and respiratory features of life-threatening anaphylaxis. Postoperative skin tests in these two patients were positive for antibiotics and concurrently positive for rocuronium.
CONCLUSIONS
Our present report suggests the possibility that both prophylactic antibiotics and NMBA concurrently and synergistically enhance anaphylactic reaction and the necessity to differentiate an immune mechanism from non-immune mechanisms when anesthesiologists encounter concurrent positive skin tests for both antibiotics and NMBA.
背景
预防性抗生素和神经肌肉阻滞剂（NMBA）是麻醉诱导后过敏反应的两大主要致病因素。
病例报告
一名女性和一名男性患者（分别为29岁和69岁）在麻醉诱导后使用预防性抗生素后发生了Ring和Messmer分级III级过敏反应。他们表现出危及生命的过敏反应典型的血流动力学和呼吸特征。这两名患者术后的皮肤试验显示对抗生素呈阳性，同时对罗库溴铵也呈阳性。
结论
我们目前的报告提示预防性抗生素和NMBA可能同时协同增强过敏反应，并且当麻醉医生遇到抗生素和NMBA皮肤试验同时呈阳性时，有必要区分免疫机制和非免疫机制。
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