レミフェンタニル塩酸塩に対する非IgE介在性のアナフィラキシーが疑われた1例

抄録

  Opioid-induced anaphylactic reactions are reported to be rare. We experienced a case of suspected anaphylactoid reaction to remifentanil.

  The patient was a 19-year-old male (height, 166 cm ; weight, 56 kg) with a history of a gag reflex. The patient had previously received general anesthesia on three separate occasions. Although no problem was encountered during the first induction of general anesthesia for dental treatment, anaphylactic shock developed during the second and third inductions of general anesthesia. During the second induction of general anesthesia, the patient developed hypotension along with skin and respiratory symptoms. Thus, the planned dental treatment was abandoned. Before the third general anesthesia, prick tests and skin tests for propofol, rocuronium bromide, and remifentanil hydrochloride were performed, and the results were negative for all these agents. Since there was a possibility of false-negative results, general anesthesia was performed without rocuronium bromide, which was the most likely causative agent of the anaphylactic reaction. However, generalized redness and hypotension were again observed. Since remifentanil hydrochloride was used during both the second and third inductions of general anesthesia, we decided to avoid remifentanil during the fourth induction of general anesthesia.

  Instead, we planned to induce general anesthesia using the Volatile Induction and Maintenance of Anesthesia (VIMA) technique combined with a translaryngeal block. Anesthesia was induced with oxygen-sevoflurane. After the translaryngeal block with lidocaine hydrochloride, nasotracheal intubation was performed. The patient was eventually able to receive dental treatments for multiple decayed teeth. No major problems, including anaphylactic symptoms, were observed during the perioperative period.