Expert: Dr Ian Jackson - please note UK based - 1/16/2009

Question
QUESTION: My husband was recently admitted to hospital for a knee replacement operation.  He was given a general anesthetic and suffered an allergic reaction. Obviously surgery was cancelled; he spent the night in HDU and recovered.  We have subsequently been told that he suffered anaphylaxis and that it may have been caused by the penicillin that was given at the same time (Augmentin).  He has no history of penicillin allergy and has had general anethestics in the past. Is this a common reaction?  Would this have been a severe reaction?  There are lots of questions that we feel we would like answered.  Is it possible to know whether is was the anesthetic or the penicillin?  He still feels very tight chested and light headed.  Should we be concerned?  He is due to have the surgery rescheduled, but may have a spinal block instead.  Is this a safer option for him?

ANSWER: Hi there Josi
I am sorry to hear about the trouble your husband had but relieved that he was managed well and has come through it. Penicillin allergy though fairly rare can start at any stage in life and is typically occurs in someone who has had previous doses of the drug with no problems.
It occurs when a persons body decides to create antibodies to the drug for some reason. Your body is designed to do this to fight off infection but unfortunately the system can become activated to many different drugs.
When the person who has become sensitive is then given a dose of the drug then the body activates a huge response which we call 'anaphylaxis'. It results in low blood pressure, problems breathing and often swelling over parts of the body (sometimes markedly on the face) and has to be treated quickly or it can be fatal.
That's a bit of the background.
If we have someone have problems like this then we run a series of tests to confirm which drug (or drugs) caused the problem. Augmentin could have been the cause but then the timing of his reaction is fairly important. Did it happen before his general anaesthetic started or had he already been anaesthetised. If he was already asleep then any of the drugs used at the induction of anaesthesia could also be to blame. In particular any muscle relaxants used are important as they have a high incidence of causing anaphylaxis.
So yes spinal anaesthesia is a good way forward BUT he should be investigated and told exactly what drug caused the problem so it can be avoided in the future. I don't accept it might have been the augmentin so we will avoid it from now on viewpoint. I would push for a definitive answer as to what drug caused the problem.

I hope this helps a bit.
Kind regards and I hope the op finally goes OK
Dr Ian Jackson

---------- FOLLOW-UP ----------

QUESTION: Dear Dr Jackson, Thank you so much for your quick response. We've been told that my husband was given the general anaesthetic and once he was under was then given Augemtine.  It was then that the reaction started.  We will push for a definite answer as to which drug caused the reaction as we need to know for future reference.  Is this something we should push for at the hospital where it happened or through our own GP. And should he have these tests before having a spinal block?  Regards, Josi

Answer
Hi there
You need to speak to your GP about this - I am now assuming you are in the UK. Our Association provides clear guidelines that patients should be fully investigated to confirm the causative agent. Yes unless surgery urgent we usually suggest waiting until we have the definitive results.
Our guidelines can be found at http://www.aagbi.org/publications/guidelines/docs/anaphylaxis03.pdf
All the best
kind regards
Dr Ian Jackson