Abstract
The presentation, evolution, and treatment of two cases of intraoperative allergic reactions are described. In each case, the offending agent was felt to be hydroxyethyl starch (HES), a synthetic polymer colloid solution used for intravascular volume expansion. Symptoms included urticaria, angioedema, and hypotension in the first patient, and urticaria, hypoxia, andhaemoconcentration in the second patient. Both patients had earlier received multiple drugs and/or blood products. However, HES administration in both patients immediately produced allergic symptomatology. The first patient had concurrent depression of serum total complement levels (CH50) and no elevation of plasma histamine levels, which suggested a complement-mediated reaction to HES. Levels of CH50 and histamine were not obtained from the second patient. Direct stimulation of mast cell degranulation by the offending agent, complement activation, or conventional antigen-antibody interaction in a previously exposed patient may initiate intraoperative allergic reactions. Anaesthesia personnel should be aware of the risk of intraoperative allergic reactions to HES and be prepared to treat them rapidly and effectively.
Résumé
La présentation, évolution et traitement de deux cos de réactions allergiques per-opératoires est décrite. Dans les deux cas, l’agent causal suggéré était l’hydroxyethyl starch(HES); une solution colloide de polymer synthétique utilisié pour l’expansion volémique. Les symptomes incluent l’urticaire, l’angioedème et l’hypotension pour le premier patient et l’urticaire, hypoxie et hémoconcentration pour le second patient. Les deux patients avaient regu au préalable de multiples médicaments etou des produits du sang. Cependant, l’administration de HES aux deux patients a produit une réaction allergique immédiate. Le premier patient avait montre une dépression du niveau sérique de complément total (CH50) et aucune élevation des niveaux d’histamine plasmatique, suggérant ainsi une réaction déclenchée par le complément.. Les niveaux de CH50 et d’histamine n’étaient pas obtenus pour le deuxieme patient. Une stimulation directe aboutissant à la dégranulation des mastocitespar Vagent causal, L’activation du complément, ou une interaction conventionnelle entre antigène-anticorps chez un sujet exposé au prealable peut initier une réaction allergique per-opératoire. Le personnel anesthésique doit être aux aguets des risques allergiques per-opé-ratoires lors de l’administration du HES et être préparé à les trailer rapidement et efficacement.
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Porter, S.S., Goldberg, R.J. Intraoperative allergic reactions to hydroxyethyl starch: A report of two cases. Can Anaesth Soc J 33, 394–398 (1986). https://doi.org/10.1007/BF03010756
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DOI: https://doi.org/10.1007/BF03010756