A patient undergoing anaesthesia for coronary artery bypass surgery developed what was subsequently confirmed to be an anaphylactic reaction to succinylated gelatin (Gelofusine®). By virtue of being on cardiopulmonary bypass, rapid detection, quantification and treatment of volume loss (by vasodilatation and extravasation) was possible. The patient required 51 ml/kg of resuscitative fluids in the 15 minutes after onset of anaphylaxis, or 73% of her calculated preoperative blood volume. Alpha-adrenoceptor agonists and vasopressin were required to manage ongoing vasoplegia. This case emphasises the importance of volume resuscitation and vasopressors in the treatment of anaphylaxis.
BrownS.G.A.Cardiovascular aspects of anaphylaxis: implications for treatment and diagnosis.Curr Opin Allergy Clin Immunol2005; 5: 359–364.
2.
FisherM.Intradermal testing after anaphylactoid reaction to anaesthetic drugs; practical aspects of performance and interpretation.Anaesth Intensive Care1984; 12: 115–120.
JenkinsS., CliftonM.Gelofusine allergy – the need for identification.Ann R Coll Surg Engl2002; 84: 206–207.
5.
PepysJ., PepysE., BaldoB., WhitwamJ.Anaphylactic/anaphylactoid reaction to anaesthetic and associated agents: skin prick tests in aetiological diagnosis.Anaesthesia1994; 49: 470–475.
6.
RussellW., FenwickD.Anaphylaxis to Haemaccel and cross reactivity to Gelofusine.Anaesth Intensive Care2002; 30: 481–483.
7.
RingJ., MessmerK.Incidence and severity of anaphylactoid reactions to colloid volume substitutes.Lancet1977; 1: 466–469.
8.
SingbartlK., InnerhoferP., RadvanJ., WestphalenB., FriesD., StögbauerR.Hemostasis and hemodilution: a quantitative mathematical guide for clinical practice.Anesth Analg2003; 96: 929–935.
9.
BrownS.G.A.Anaphylaxis: clinical concepts and research priorities.Emerg Med Australas2006; 18: 155–169.
10.
BrownS.G.The Pathophysiology of Shock in Anaphylaxis.Immunol Allergy Clin North Am2007; 27: 165–175.
11.
FisherM.Clinical observations on the pathophysiology and treatment of anaphylactic cardiovascular collapse.Anaesth Intensive Care1986; 14: 17–21.
12.
SampsonH.A., Munoz-FurlongA., CampbellR.L., AdkinsonN.F.Jr., BockS.A., BranumA.Second symposium on the definition and management of anaphylaxis: summary report – Second National Institute of Allergy and Infectious Disease/Food Allergy and Anaphylaxis Network symposium.J Allergy Clin Immunol2006; 117: 391–397.
13.
MossJ., FahmyN.R., SunderN., BeavenM.A.Hormonal and hemodynamic profile of an anaphylactic reaction in man.Circulation1981; 63: 210–213.
14.
McBrienM.E., BreslinD.S., AtkinsonS., JohnstonJ.R.Use of methoxamine in the resuscitation of epinephrine-resistant electromagnetic dissociation.Anaesthesia2001; 56: 1082–1089.
15.
SchummerC., WirsingM., SchummerW.The Pivotal Role of Vasopressin in Refractory Anaphylactic Shock.Anesth Analg2008; 107: 620–624.
