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Peri‐operative refractory anaphylactic shock during hepatic hydatid cyst surgery

Peri‐operative refractory anaphylactic shock during hepatic hydatid cyst surgery Serious intra‐operative anaphylactic shock is an unusual complication. Identification of causative agents can be difficult due to the number of anaesthetic drugs administered in quick succession, many of which can potentially cause anaphylaxis. Most anaphylactic reactions respond to, and resolve with, adrenaline and steroids. However, they can be prolonged and life‐threatening. Refractory anaphylaxis, unresponsive to repeated doses of adrenaline, is rare and associated with a high risk of mortality. Rupture of a hydatid cyst during surgery can cause anaphylaxis. Here, we present a rare case of refractory anaphylactic shock during surgical resection of a hepatic hydatid cyst, with severe haemodynamic instability requiring prolonged postoperative ventilation and triple inotropic support for seven days in the intensive care unit. We describe the management of this condition, primarily based on steroid therapy and escalating vasopressor support, particularly where limited response to adrenaline is encountered. Refractory anaphylaxis is a rare but life‐threatening complication of hydatid cyst surgery. Therefore, anaphylactic reactions should always be anticipated, with the appropriate treatment and facilities readily available. http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Anaesthesia Reports Wiley

Peri‐operative refractory anaphylactic shock during hepatic hydatid cyst surgery

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Publisher
Wiley
Copyright
2022 © Association of Anaesthetists
eISSN
2637-3726
DOI
10.1002/anr3.12183
Publisher site
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Abstract

Serious intra‐operative anaphylactic shock is an unusual complication. Identification of causative agents can be difficult due to the number of anaesthetic drugs administered in quick succession, many of which can potentially cause anaphylaxis. Most anaphylactic reactions respond to, and resolve with, adrenaline and steroids. However, they can be prolonged and life‐threatening. Refractory anaphylaxis, unresponsive to repeated doses of adrenaline, is rare and associated with a high risk of mortality. Rupture of a hydatid cyst during surgery can cause anaphylaxis. Here, we present a rare case of refractory anaphylactic shock during surgical resection of a hepatic hydatid cyst, with severe haemodynamic instability requiring prolonged postoperative ventilation and triple inotropic support for seven days in the intensive care unit. We describe the management of this condition, primarily based on steroid therapy and escalating vasopressor support, particularly where limited response to adrenaline is encountered. Refractory anaphylaxis is a rare but life‐threatening complication of hydatid cyst surgery. Therefore, anaphylactic reactions should always be anticipated, with the appropriate treatment and facilities readily available.

Journal

Anaesthesia Reports – Wiley

Published: Jul 1, 2022

Keywords: anaphylactic shock; hydatid cyst surgery; refractory anaphylaxis

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