A clinical case of anaphylactic shock development after anesthesia induction

The article describes a clinical case when a patient who was supposed to have a planned surgery on the spine developed anaphylactic shock. After 10 minutes of anesthesia introduction, the patient developed severe hypotension (resistant to the administration of adrenomimetics) and tachycardia; a decrease in the partial pressure of carbon dioxide at the end of expiration was noted. Due to the rapid development of a critical condition, the absence of specific skin manifestations and allergic history, as well as a direct association with the administration of a specific agent, it was necessary to carry out a differential diagnosis between acute myocardial infarction, pulmonary embolism, and anaphylactic shock. During the intensive care, the patient had echocardiography and ECG, blood gases were tested; the decisive diagnostic factor was the identification of bronchospasm signs. When the condition was stabilized, angiography of the vessels of the heart and lungs was performed; later, the agent that caused the development of anaphylaxis was established.Identifying the cause of hypotension after induction of anesthesia is critical because therapy can vary significantly. The development of anaphylactic shock during general anesthesia is not common but delayed diagnosis and therapy can be fatal. The article discusses modern approaches to the diagnosis and therapy of perioperative anaphylaxis using the example of the presented clinical case.

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Delayed Diagnosis of Unilateral Mandibular Condylar Fracture in a Posterior Edentulous Patient

Case Reports in Dentistry ◽

10.1155/2021/5579236 ◽

2021 ◽

Vol 2021 ◽

pp. 1-4

Author(s):

Sahani Anupama ◽

Pilana Vithanage Kalani Shihanika Hettiarachchi

Keyword(s):

Early Diagnosis ◽

Clinical Case ◽

Delayed Diagnosis ◽

Mandibular Fractures ◽

Edentulous Patient ◽

Condylar Fracture ◽

Physical Finding ◽

Case Presentation ◽

Edentulous Patients ◽

Condylar Fractures

Background. Fractures of the mandible are common in elderly patients, and among them, condylar fractures are the most frequent type. A change in occlusion is the most common physical finding in patients with fractures of the mandible. Therefore, it is challenging to identify mandibular fractures in posterior edentulous patients due to the lack of posterior occlusal contacts. It is crucial to do radiological investigations in such patients to exclude fractures. Case Presentation. This article describes a case of delayed diagnosis of a unilateral mandibular condylar fracture for a week’s duration and treating the condition as temporomandibular pathology in a posterior edentulous, 52-year-old patient. Conclusion. This clinical case highlights the importance of radiological investigations and occlusal analysis for early diagnosis of condylar fractures, particularly in posterior edentulous patients, lacking posterior occlusal contacts.

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Scleroderma-panniculitis: view of the rheumatologist

Modern Rheumatology Journal ◽

10.14412/1996-7012-2021-2-77-82 ◽

2021 ◽

Vol 15 (2) ◽

pp. 77-82

Author(s):

A. S. Potapova ◽

O. N. Egorova ◽

O. G. Alekseeva ◽

A. V. Volkov ◽

D. M. Kudinsky

Keyword(s):

Magnetic Resonance Imaging ◽

Magnetic Resonance ◽

Histological Examination ◽

Antiphospholipid Syndrome ◽

Clinical Case ◽

Soft Tissues ◽

Resonance Imaging ◽

Diagnosis And Therapy

Difficulties in diagnosis and therapy of scleroderma-panniculitis (S-PN), one of the variants of the septal PN, are discussed. Feasibility of ultrasonography, magnetic resonance imaging of soft tissues and histological examination of the lesions in order to set the diagnosis of PN in time is considered. The clinical case of S-PN combined with antiphospholipid syndrome is presented.

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Mepivacaine-induced anaphylactic shock in a pregnant woman undergoing combined spinal and epidural anesthesia for cesarean delivery: a case report

JA Clinical Reports ◽

10.1186/s40981-019-0302-6 ◽

2019 ◽

Vol 5 (1) ◽

Cited By ~ 4

Author(s):

Miyuki Takahashi ◽

Kunihisa Hotta ◽

Soichiro Inoue ◽

Tomonori Takazawa ◽

Tatsuo Horiuchi ◽

...

Keyword(s):

Case Report ◽

Cesarean Delivery ◽

Epidural Anesthesia ◽

Anaphylactic Shock ◽

Vital Signs ◽

Birth Asphyxia ◽

Causative Factor ◽

Fetal Heart Rate Monitoring ◽

Developmental Problems ◽

Severe Hypotension

Abstract Background Anaphylactic shock during pregnancy is a rare but life-threatening event for both the mother and the newborn. Case presentation A 42-year-old woman, who was pregnant with twins, was scheduled for cesarean delivery under combined spinal and epidural anesthesia. An epidural catheter was placed uneventfully. After spinal anesthesia, the patient exhibited skin symptoms and severe hypotension. The patient was diagnosed with anaphylaxis, and subsequently, treatment was started. Fetal heart rate monitoring revealed sustained bradycardia, and it was decided to proceed with cesarean delivery. After delivery, the mother’s vital signs recovered. Both infants were intubated due to birth asphyxia. Currently, the twins are 4 years old and exhibit no developmental problems. Clinical examination identified mepivacaine as the causative agent of anaphylaxis. Conclusions This case report highlights that upon occurrence of anaphylaxis during pregnancy, maternal treatment and fetal assessment should be started immediately. Indication for immediate cesarean delivery should be considered and a definite identification of the causative factor pursued.

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Fulminant diabetes mellitus and concomitant enterovirus infection: a clinical case

Medical Journal of the Russian Federation ◽

10.18821/0869-2106-2020-26-2-125-132 ◽

2020 ◽

Vol 26 (2) ◽

pp. 125-132

Author(s):

T. V. Saprina ◽

N. N. Musina ◽

S. V. Vtorushin ◽

N. V. Krakhmal’ ◽

Yu. V. Rogovskaya

Keyword(s):

Diabetes Mellitus ◽

Management Strategy ◽

Clinical Case ◽

Rapid Development ◽

Fulminant Type 1 Diabetes ◽

Pancreatic Cells ◽

Total Destruction ◽

Fulminant Diabetes ◽

Fulminant Type

Fulminant type 1 diabetes mellitus is a subtype of diabetes mellitus. It is characterized by the extremely rapid development of hyperglycemia and ketoacidosis because of the near-total destruction of pancreatic -cells. A clinical case of lethal, type 1, fulminant diabetes mellitus is presented. The patient management strategy and possible causes of the adverse course and outcome of the disease are analyzed.

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Left Frontal Lobe Tumor-Induced Intraoperative Premature Ventricular Beats

Journal of Neuroanaesthesiology and Critical Care ◽

10.1055/s-0041-1731978 ◽

2021 ◽

Author(s):

Parmod K. Bithal ◽

Ravees Jan ◽

Bharani Kumar ◽

Insha ur Rahman

Keyword(s):

Blood Gases ◽

Postoperative Recovery ◽

Anesthesia Induction ◽

Raised Intracranial Pressure ◽

Normal Blood Pressure ◽

Left Frontal Lobe ◽

Premature Ventricular Contractions ◽

Cardiac Pathology ◽

Neurosurgical Patients ◽

Cardiac Evaluation

AbstractIn the absence of cardiac pathology, premature ventricular contractions (PVCs) in neurosurgical patients frequently accompany subarachnoid hemorrhage, intracerebral hemorrhage, traumatic brain injury, or raised intracranial pressure. PVCs detected during preanesthesia assessment prompts detailed cardiac evaluation. Our 57-year-old patient, a case of left frontal meningioma, with controlled hypertension, diabetes and hypothyroidism, had normal preoperative ECG and potassium. However, immediately on anesthesia induction, she developed multiple refractory to treatment PVCs but with normal blood pressure. Anesthesia, which was maintained with sevoflurane and fentanyl, was deepened to exclude light anesthesia as the cause, without useful outcome. Two lignocaine boluses (100 mg each), followed by its infusion, also proved ineffective. Her blood gases and potassium, checked twice, were normal. Throughout, her hemodynamics remained stable. As soon as tumor was removed, the PVCs disappeared not to return. Her postoperative recovery was uneventful with normal ECG.

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Hemodynamic and regional circulatory alterations in dog during anaphylactic challenge

AJP Heart and Circulatory Physiology ◽

10.1152/ajpheart.1985.249.2.h430 ◽

1985 ◽

Vol 249 (2) ◽

pp. H430-H437 ◽

Cited By ~ 1

Author(s):

M. A. Kapin ◽

J. L. Ferguson

Keyword(s):

Blood Flow ◽

Cardiac Output ◽

Anaphylactic Shock ◽

Peripheral Resistance ◽

Cardiac Performance ◽

Severe Hypotension ◽

Pressure Compensation ◽

Arteriovenous Difference ◽

The Brain ◽

Arterial Glucose

Microspheres were employed to measure the cardiac output (CO), percent distribution of CO (%CO), and blood flow (BF) to various tissues in the dog during anaphylactic shock. Five minutes after challenge there was a 66 and 83% drop from control for mean arterial pressure and CO, respectively. Arterial glucose and lactic acid rose 62 and 537%, respectively. Furthermore, there was a narrowing of the systemic arteriovenous difference for PO2 and a widening of the venoarterial difference for PCO2. Pressure compensation toward control values began 5 min postchallenge and continued through 180 min. Circulatory perturbations during severe hypotension (less than mmHg) included depressed %CO and BF to the pancreas and spleen and elevated %CO to the brain and adrenals. Cerebral and adrenal BF remained unchanged at this period. BF to the kidneys, liver (hepatic artery), and gastrointestinal tract dropped markedly as a function of increased peripheral resistance and decreased CO. As cardiac performance improved, blood flow to the pancreas, spleen, liver, diaphragm, and gastrointestinal tissues returned toward control but was elevated to the adrenals and decreased to the brain.

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Current Status of the Identification and Management of Tinea Capitis

PEDIATRICS ◽

10.1542/peds.72.5.625 ◽

1983 ◽

Vol 72 (5) ◽

pp. 625-631

Author(s):

Daniel P. Krowchuk ◽

Anne W. Lucky ◽

Susan I. Primmer ◽

Joseph McGuire

Keyword(s):

Children And Adolescents ◽

Health Problem ◽

Tinea Capitis ◽

Delayed Diagnosis ◽

Current Status ◽

Trichophyton Tonsurans ◽

Diagnosis And Therapy ◽

Therapeutic Measures ◽

Clinical Patterns ◽

Significant Health

Tinea capitis due to Trichophyton tonsurans has become a significant health problem affecting children and adolescents. This infection has several different distinctive clinical patterns which, if not recognized, may result in delayed diagnosis and therapy. This review is designed to emphasize the differences between tinea capitis caused by T tonsurans and that caused by other organisms. Current diagnostic and therapeutic measures are discussed.

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Case report of a massive pseudoaneurysm of the anterior tibial artery

I P Pavlov Russian Medical Biological Herald ◽

10.17816/pavlovj70498 ◽

2021 ◽

Vol 29 (2) ◽

pp. 293-298

Author(s):

Anna Dorn ◽

Peter Galkin ◽

Egan Kalmykov ◽

Payman Majd

Keyword(s):

Therapeutic Strategy ◽

Delayed Diagnosis ◽

Clinical Signs ◽

Arterial Injury ◽

The Body ◽

Anterior Tibial Artery ◽

Medical Procedures ◽

Diagnosis And Therapy ◽

Anterior Tibial ◽

History Of

The majority of arterial pseudoaneurysms treated in our department of vascular surgery are consequences of catheter-associated medical procedures and located in the groin region. Clinical signs, combined with the recent history of a percutaneous intervention, ensure quick diagnosis and therapy. However, pseudoaneurysms can develop after any artery of the body is injured. No consensus on the therapeutic strategy is achieved because of the rare nature of this injury. This study provided an overview of the methods described in previous studies and contributions to their clinical experience. A case of a young man whose injury was not recognized immediately and who presented months after the accident with a pseudoaneurysm of unusual location and size was reported. Sonographic diagnosis was confirmed through computed tomography angiography, and open surgical repair was performed with satisfactory results. Conclusion. This case is a reminder that seemingly minor accidents can cause arterial injury, and patients should be carefully examined to avoid delayed diagnosis and therapy.

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