Department of Surgery, Trinity HealthAnn Arbor Hospital, Ypsilanti, MI, USA.
Am Surg. 2023 Dec;89(12):6407-6409. doi: 10.1177/00031348231206584. Epub 2023 Oct 16.
Intravenous indocyanine green (IV ICG) is regarded as a safe immunofluorescence agent used to assess bowel perfusion prior to creating bowel anastomoses and aids in ureter identification during intra-abdominal surgery. We report the first instance of anaphylactic shock to IV ICG after prior toleration of ICG via an intra-ureteral route. Shortly after administering IV ICG, our patient became hypotensive and hypoxic requiring chest compressions, vasoactive medications, and thoracostomy tubes prior to identifying the symptoms as an allergic reaction. Anaphylaxis is not a recognized side effect of ICG and was not immediately considered. As ICG becomes increasingly utilized as an immunofluorescence agent among surgical specialties, increased awareness and recognition of anaphylactic shock as a potential side effect of ICG may lead to expedited diagnoses, treatment, and more critical evaluation of indications for future use. Additionally, our patient first tolerated intra-ureteral administration without a systemic reaction, suggesting a possible sensitization mechanism.
静脉注射吲哚菁绿（IV ICG）被认为是一种安全的免疫荧光剂，可用于评估肠吻合术前的肠灌注，并有助于在腹腔内手术中识别输尿管。我们报告了首例经输尿管途径耐受 ICG 后对 IV ICG 发生过敏休克的病例。在给予 IV ICG 后不久，我们的患者出现低血压和低氧血症，需要进行胸外按压、血管活性药物治疗和胸腔引流管插入，然后才确定症状为过敏反应。过敏反应不是 ICG 的已知副作用，因此并未立即考虑。随着 ICG 作为免疫荧光剂在外科专业中越来越多地被使用，提高对过敏休克作为 ICG 潜在副作用的认识可能会导致更快速的诊断、治疗，并对未来使用的适应证进行更严格的评估。此外，我们的患者首次耐受了输尿管内给药而没有全身反应，这表明可能存在致敏机制。
