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Anesthesiology/Allergy to anesthesiology

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Expert: Dr Ian Jackson - please note UK based - 11/22/2010


Question

anesthesia record
I am writing from Iran. My sister 25 year-old had a septal deviation ( septoplasti) surgery on August 2010. During surgery in general anesthesia after injection of epinephrine she had arythmia, then they inject xylocaine which did not response then she developed bradycardia so they gave her atropine she developed sinus tachycardia then they gave 2mg inderal two times and propofol and other medications which is mentioned in the file I attacheed. after extubation she developed acute pulmonary edema. she has history of allergic reaction to shrimp. now I would like to know what are the possible causes of this condition and how to prevent the problem for future conditions. here doctors said it is a rare case and she should be admitted and be tested which has the same risk as the problem happened during surgery.  

Answer
Hi there
It certainly sounds like your sister had a stormy time. It is very difficult to read the chart you have sent but it appears she had traditional GA with the addition of a Remifentanil infusion which is a very short acting but potent analgesic (pain killer). It would be difficult to untangle all that happened without interviewing those present. However dysrythmias can happen after injection of epinephrine.
The bottom line after all that happened it is not surprising she developed pulmonary oedema. This could be secondary to an allergy to one of the drugs she was given or it could even be secondary to a period of straining to breathe after extubation. If they suspected an allergic reaction then I would expect that they would have taken blood samples for tryptase levels. This is helpful in assessing if a reaction is secondary to an allergic response.
Useful guidelines can be found here
http://www.aagbi.org/publications/guidelines.htm#A

If they haven't then you are left in a bit of a quandry at it may be best to ask for expert advice about testing for allergy to the drugs used. This should only be undertaken by an expert who can perform skin testing and interpret the results.
My gut feeling is they probably won't find much and that this issue was the result of how your sisters anaesthetic was managed.
Sorry can't help further and as I'm unsure of the medical setup in your country I can't really give any further advice.
Kind regards
Dr Ian Jackson

Dr Ian Jackson - please note UK based

Expertise

I am a Consultant Anaesthetist in the UK. My interests include ambulatory or day surgery, obstetric anaesthesia and analgesia, acute pain management (use of epidurals and patient controlled analgesia)anaesthesia for surgery on the airway, orthopaedics and most things except brains and hearts. Interest in prehospital care of trauma and provision of medical cover at motorsport events.

Experience


Organizations
European Society of Regional Anaesthesia
British Association of Day Surgery
Obstetric Anaesthetists Association
Association of Anaesthetists

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