全身麻酔中に非IgE介在性のアナフィラキシーを引き起こした1例

抄録

The patient was a 34-year-old male scheduled for submucous resection of the nasal septum and inferior nasal concha. Shortly after the administration of 2 g piperacillin to prevent postoperative infection, he suffered a sudden cardiovascular collapse (systolic blood pressure 44 mmHg, heart rate 93 beats per minute, 87 % SpO₂). At first, we considered this was caused by vasodilator effects from the anesthetic and we administered phenylephrine, which did not stabilize his hemodynamic status. In addition, erythema developed on his thigh. Because we suspected anaphylactic shock, anesthetic drugs were discontinued immediately and resuscitative treatment began. A diagnosis of anaphylactoid reaction was confirmed from blood tests that showed normal non-specific IgE antibody levels, low serum complement, high plasma histamine, and high plasma tryptase. Although an intradermal test revealed a positive reaction to piperacillin, we could not totally rule out other drugs that might have been involved in the reaction. Subsequently, the operation was performed uneventfully under local anesthesia.