Summary
Background. The incidence of events during anaesthesia that lead to adverse outcomes, is estimated to be between 1:10 000 and 1:100 000. Beta lactam antibiotics are among the drugs that most often lead to allergic reactions and anaphylaxis, with IgE mediated reactions being the most common. Up to one-tenth of these episodes are life-threatening, with the most serious reactions occurring in patients with no proper diagnosis and/or anamnesis. We describe the case of a 59- year-old male patient who had a severe allergic reaction to amoxicillin-clavulanic acid prior to the induction of anaesthesia.
Case report. The patient, ASA class 3, with a long history of diffuse atherosclerosis, had previously undergone two femoral-popliteal bypasses, and was scheduled for internal iliac surgery. He received orally 7.5 mg midazolam for premedication. In the operating theatre, after establishing peripheral venous access, he received a prophylactic injection of 1.2 g amoxicillin-clavulanic acid intravenously. A few minutes later, he became restless, lost consciousness and suffered a cardiac arrest. CPR was commenced, and after 1 mg of adrenaline, spontaneous cardiac electrical activity and cardiac output was restored. He also received 100 mg of hydrocortisone. The surgery was cancelled and the patient was transferred to the ICU to be extubated four hours later. Because of a high serum tryptase concentration (24 ?g l^-1), an IgE allergic reaction was diagnosed. Skin tests, performed six weeks later, confirmed a selective allergy to aminopenicillins.
Discussion and conclusions. Anaphylactic reactions related to anaesthesia and surgery are rarely reported in Poland. Early symptoms may be masked by premedication and anaesthesia, and the use of various drugs during induction makes selection of the precipitating factor difficult. In every case of a suspected anaphylactic reaction, the serum beta-tryptase concentration should be analysed.