PDF(Pubmed)
Abstract：
Peri-anesthetic anaphylaxis is a rare but grave problem. After receiving informed consent for publication, we discuss the case of a female patient posted for laparoscopic cholecystectomy who developed an anaphylactic reaction to intravenous diclofenac, mimicking post-laparoscopy respiratory complication in the perioperative period. A 45-year-old, American Society of Anesthesiologists physical status (ASA-PS) I, female patient was posted for laparoscopic cholecystectomy under general anesthesia (GA). The procedure took 60 minutes and concluded uneventfully. In the post-anesthesia care unit, the patient complained of respiratory difficulty. Even after the supplemental oxygen and in absence of any significant finding on respiratory examination, the patient soon developed severe cardiorespiratory collapse. On evaluation, administration of intravenous diclofenac a few minutes before the event was suspected as the trigger for this anaphylactic response. The patient responded to the injection of adrenaline, and her post-surgical progress over the next two days was uneventful. The retrospective tests done for confirming diclofenac hypersensitivity were found to be positive. No drug, however safe, should be given blindly without proper observation and monitoring. The course of development of anaphylaxis can range from a few seconds to minutes and hence, the earliest recognition and prompt action can be the only deciding factor between life and death for such patients.
摘要：
围麻醉过敏反应是一个罕见但严重的问题。在获得知情同意书发表后，我们讨论了一个女性患者进行腹腔镜胆囊切除术，对静脉双氯芬酸产生过敏反应，在围手术期模仿腹腔镜术后呼吸系统并发症。一个45岁的人,美国麻醉医师协会身体状况（ASA-PS）I，女性患者在全身麻醉(GA)下接受腹腔镜胆囊切除术.该程序花了60分钟，并顺利结束。在麻醉后护理室，患者主诉呼吸困难。即使在补充氧气之后，并且在呼吸检查中没有任何重要发现，病人很快出现了严重的心肺衰竭。关于评估，在该事件发生前几分钟静脉注射双氯芬酸被怀疑是该过敏反应的触发因素.病人对注射肾上腺素有反应，在接下来的两天里，她的术后进展顺利。发现为确认双氯芬酸超敏反应而进行的回顾性测试为阳性。没有药物,然而安全,应该盲目给予，没有适当的观察和监测。过敏反应的发展过程可以从几秒钟到几分钟，因此，最早的识别和及时的行动可能是此类患者生与死之间的唯一决定因素。
