PDF(Pubmed)
Abstract：
Perioperative hypersensitivity reactions vary from mild to potentially fatal anaphylaxis, resulting in significant morbidity and mortality. Most of the perioperative hypersensitivity and allergic reactions are attributed to antibiotics, antiseptic solutions, latex, and opioids. In the current thrust for opioid-free anesthesia, owing to its multiple advantages, paracetamol and nonsteroidal antiinflammatory agents play a significant role in multi-modal pain and inflammatory response management. Nearly nine out of ten individuals experience postoperative pain, one-third experience postoperative nausea and vomiting, and one-fourth experience fever, irrespective of surgery and type of anesthesia, often as an inflammatory response. While perioperative hypersensitivity reactions are common, a patient allergic to multiple commonly used drugs for the treatment of pain, fever, acid-peptic disorder, and nausea and vomiting is scarce. Such cases pose a great challenge in perioperative management. A 14-year-old male child with a traumatic foot drop planned for tibialis posterior tendon transfer developed an allergic reaction with mild fever following an injection of Ranitidine and Ondansetron in the preoperative area. Surgery was deferred and was investigated for allergy profile testing for commonly used drugs, which showed high IgE levels and moderate to severe hypersensitivity for diclofenac and paracetamol. The patient was operated on after one month under spinal anesthesia, avoiding ranitidine, ondansetron, diclofenac, and paracetamol. The following morning, he developed a high-grade fever (102.3° F), which did not resolve with conservative measures. Hypersensitivity and allergic reactions to NSAIDs are reported in the literature. While there are multiple drugs available as NSAIDs, cross-sensitivity or allergy to other drugs within the same group, and even chemically related groups, is also another possibility that needs to be considered while managing such patients. Mefenamic acid controlled the fever, and the child was discharged home after 48 hours of observation. However, the case posed a great perioperative management dilemma; the present report intends to highlight and discuss it.
摘要：
围手术期的过敏反应从轻度到潜在致命的过敏反应不等。导致显著的发病率和死亡率。大多数围手术期的过敏和过敏反应归因于抗生素，防腐解决方案，乳胶，和阿片类药物。在目前无阿片类药物麻醉的推动下，由于其多重优势，扑热息痛和非甾体抗炎药在多模式疼痛和炎症反应管理中发挥重要作用.近十分之九的人经历术后疼痛，1/3术后恶心呕吐,和四分之一的发烧经验，不管手术和麻醉类型，通常作为炎症反应。虽然围手术期过敏反应很常见，对多种常用治疗疼痛的药物过敏的患者，发烧,酸消化性疾病,恶心和呕吐很少。此类病例对围手术期管理提出了巨大挑战。一名14岁的男性儿童在术前区域注射雷尼替丁和昂丹司琼后，计划进行胫骨后肌腱转移，导致轻度发烧，出现过敏反应。手术被推迟，并接受了常用药物的过敏概况测试。显示高IgE水平和对双氯芬酸和对乙酰氨基酚的中度至重度超敏反应。患者在脊髓麻醉下手术一个月后，避免雷尼替丁,昂丹司琼,双氯芬酸,和扑热息痛.第二天早上,他发高烧（102.3°F），这并没有以保守的措施解决。文献中报道了对NSAIDs的超敏反应和过敏反应。虽然有多种药物可作为NSAIDs，对同一组内的其他药物的交叉敏感性或过敏，甚至是化学相关的群体，也是管理此类患者时需要考虑的另一种可能性。甲芬那酸控制了发烧，观察48小时后，孩子出院回家。然而,该病例带来了巨大的围手术期管理困境；本报告旨在强调和讨论它。
