Anaphylactoid Shock with Infusion of 5% Albumin in a Patient under General Anesthesia英文文献资料.docVIP

Open Journal of Anesthesiology, 2012, 2, 214-216 /10.4236/ojanes.2012.25048 Published Online November 2012 (http://www.SciRP.org/journal/ojanes) Anaphylactoid Shock with Infusion of 5% Albumin in a Patient under General Anesthesia Samer Abdel-Aziz, Esamelden Abdelnaem, Neeraj Kumar, Mohamed Ismaeil Department of Anesthesiology, University of Arkansas for Medical Sciences, Little Rock, USA. Email: sabdelaziz@ Received August 13 , 2012; revised September 14 , 2012; accepted September 30 , 2012 th th th ABSTRACT A 61 years old male patient undergoing gastrectomy under general anesthesia developed severe anaphylactoid shock after 15 minutes from starting 5% albumin infusion. His blood pressure went from 101/67 down to 44/23 with his heart rate going up from 91 to 99. A total of 1600 mcg of phenylephrine were given without any improvement in the hemo- dynamics. We then gave 50 mcg of Epinephrine to which blood pressure rapidly responded going up to 141/60 (mean 88). Then 15 mg of Dexamethasone were given. Blood pressure remained stable with the mean between 75 and 90, without requiring anymore pressors. 5% albumin is considered among the safer colloids with a risk of anaphylactoid reactions less than gelatins and dextrans and comparable to starches. However, severe life threatening anaphylaxis has been reported with Albumin infusion. With the still ongoing crystalloid colloid debate, with many studies showing no survival benefit with colloid use for volume resuscitation, the risk of severe anaphylactic shock, even with the safer colloids like albumin should drive to a more conservative use of albumin for volume resuscitation, specially under gen- eral anesthesia, when recognizing the signs and symptoms of anaphylaxis and the offending agent maybe more chal- lenging. Keyw