Cardiorespiratory arrest due to grade IV anaphylactic shock with succinylcholine , report of a case and review of the literature.: Research Article

Bachar Loukoumi Oumar

doi:10.58372/2835-6276.1204

Authors

Bachar Loukoumi Oumar Medecin

DOI:

https://doi.org/10.58372/2835-6276.1204

Keywords:

anaphylactic shock, curares, cardiac arrest, suxamethonium, Abbeville, France

Abstract

Anaphylactic shock caused by anesthetic agents is a serious complication that can lead to the death of the patient despite well-conducted resuscitation. Succinylcholine is the primary source of anaphylactic shock in anesthesia. Used for over 60 years as the product of choice in emergency situations and during difficult intubation; its use is wide in all countries of the globe. We report the observation of a 77-year-old patient who underwent ophthalmological surgery under general anesthesia. After induction with propofol and placement of a laryngeal mask, a decision to orotracheal intubation was made given the ventilation difficulties. An anesthetic protocol combining a hypnotic to deepen the narcosis with propofol and curarization using suxamethonium was chosen. A few minutes after intubation, ventilator capnia is undetectable and the pulse is unobtainable while an ECG tracing persists. CPR is performed by external cardiac massage, bolus injection of adrenaline (4 mg in cumulative doses) associated with manual ventilation with FIO2 at 100%, cessation of any current product, filling with crystalloids and 250ml of bicarbonate 4, 2%. An effective pulse and blood pressure are found after no-flow for one (1) minute and low-flow for 10 minutes. Samples were taken for additional explorations. With the success of cardiopulmonary resuscitation and non-urgent surgery, it was decided not to begin the intervention and to transfer the patient to intensive care for continued treatment in the face of suspicion of serious anaphylactic shock. After twenty-four (24) hours of monitoring, he was extubated and his release from intensive care was authorized after the seventy-second hours. The allergological consultation carried out after the event concluded that there was allergic hypersensitivity to suxamethonium, a molecule contraindicated for life in this patient.

References

Malinovsky JM, C tacquard. AM Chiriac et al. News on curare anaphylaxis. Rev Fr Allergology. 2017. 547-550.

Gronert GA . Cardiac arrest after succinylcholine: mortality greater with rhabdomyolysis than receptor upregulation. Anesthesiology. March 2001;94(3):523 -529.

Mertes PM, Alla F, Tréchot P, Auroy Y, Jougla E, Study group of peranesthetic anaphylactoid reactions. Anaphylaxis during anesthesia in France: an 8-year national survey. J Allergy Clin Immunol 2011; 128:366–73.

M. Fourel a, N. Diot b, R. Dubost b et al . Demonstration of sensitization to curares during the diagnosis of an allergy to pholcodine. Revue française d’allergologie 52 (2012) 97–100.

Mertes PM, Tajima K, Regnier-Kimmoun MA, Lambert M, Iohom G et al. Perioperative anaphylaxis. Med Clin North Am 2010; 94:761–89.

Dong SW, Mertes PM, Petitpain N, Hasdenteufel F et al. Hypersensitivity reactions during anesthesia. Results from the ninth French survey (2005–2007). Minerva Anestesiol 2012; 78:868-78.

C. Dauthier, M. Le Dorze, C. Le Coq et al : Choc anaphylactique à la succinylcholine : revue de la littérature, analyse d’une augmentation locale d’incidence, à propos de 18 cas. AFAR.2014.98-99.

Beaupre PN, Roizen MF, Cahalan MK, et al. Hemodynamic and twodimensional transesophageal echocardiographic analysis of an anaphylactic reaction in a human. Anesthesiology. 1984;60(5):482-484.

Mitsuhata H, Hasome N, Saitoh J et al. Evaluation of left ventricular diastolic function in IgEmediated anaphylaxis in dogs. Acta Anaesthesiol Scand. août 1995;39(6):791-796.

Mertes PM, Pinaud M. [What are the physiopathological mechanisms? How can severe anaphylactoid reactions be explained]. Ann Fr Anesth Reanim. mai 2002;21 Suppl 1:55s-72s.

Smith HM, Jacob AK, Segura LG, Dilger JA, Torsher LC. Simulation education in anesthesia training: a case report of successful resuscitation of bupivacaine-induced cardiac arrest linked to recent simulation training. Anesth Analg. mai 2008;106(5):1581-1584, table of contents.

Laroche D, Debaene B. et al. How to relate the observed event to anaphylaxis? Practice of diagnostic investigations. Ann Fr Anesth Reanim. mars 2011;30(3):280-293.