We treated a patient who experienced anaphylactic shock during intravenous sedation.
A 24-year-old woman (height : 167 cm, weight : 57 kg) suffered from atopic dermatitis, bronchial asthma, and food-dependent, exercise-induced anaphylaxis.
Tooth extraction under intravenous sedation was performed using midazolam, propofol, acetaminophen, ampicillin sodium, and lidocaine with 1/80,000 adrenaline. At the end of the procedure, wheals and an erythema response appeared. An anaphylactic response with hypotension, dyspnea, wheezing, the expansion of the wheal and erythema response, edema, stomach ache, and a desire to defecate were observed. Treatment for anaphylaxis was immediately performed including the inhalation of oxygen (5 l/min), the intravenous administration of 0.25 mg of adrenaline, 100 mg of hydrocortisone sodium succinate, 6.6 mg of dexamethasone, and 500 mg of hydrocortisone sodium succinate. The patient was managed in the ICU until postoperative day 2, at which time the edema had improved. A blood examination revealed normal ranges of tryptase and histamine, a high range of non-specific IgE, and positive results for acetaminophen and midazolam, false positive results for propofol and ampicillin sodium, and negative results for lidocaine with 1/80,000 adrenaline in a drug-induced lymphocyte stimulation test (DLST). This case showed systemic changes in circulation, respiration, and her skin. Therefore, the case was considered to have experienced anaphylactic shock. However, the diagnosis of anaphylactic shock was difficult to confirm based on the results of biomarkers and blood examinations, including DLST.
