[Unclear intraoperative cardiorespiratory decompensation. Anaphylactic reaction?]

Abstract

During anaesthesia a patient is exposed to a variety of substances, all of which could lead to anaphylactic reactions. In addition, other drugs may exert clinical side-effects by non-immunological mechanisms, e.g. by direct stimulation of the release of histamine by mast cells. Initially, the observed symptoms, such as hypotension or tachycardia, may be misunderstood by the anaesthetist, leading to a possible delay in diagnosis and subsequent treatment of the anaphylactic event. Cardiac ischemia and lung embolisms are important differential diagnoses that often cannot be definitely ruled out during the acute situation and that have to be followed up once the patient has been stabilised. We report a case of anaphylactic reaction after the administration of ampicillin which required treatment and ventilation in the intensive care unit. Despite an accurate determination of serum tryptase levels, the diagnosis of an anaphylactic reaction to ampicillin was eventually confirmed by skin testing. During anaesthesia, anaesthetists should consider anaphylaxis when unforeseen symptoms such as bronchospasm, haemodynamical instability and/or flush arise. In cases of unexpected reactions, patients should undergo allergological follow-up to prevent fatal re-exposure.