Successful extracorporeal resuscitation of a probable perioperative anaphylactic shock due to atracurium

We report the case of a 55-year-old woman ASA 2 scheduled for a cholecystectomy, who presented 25 minutes after the induction, a circulatory arrest probably due to a cardiac anaphylaxis attributed to atracurium. After 60 minutes of futile resuscitation without any spontaneous cardiac rhythm a percut...

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Bibliographic Details
Published in:Annales françaises d'anesthésie et de réanimation 2005-05, Vol.24 (5), p.551
Main Authors: Lafforgue, E, Sleth, J-C, Pluskwa, F, Saizy, C
Format: Article
Language:fre
Subjects:
Anaphylaxis - chemically induced
Anaphylaxis - therapy
Atracurium - adverse effects
Cardiopulmonary Bypass
Cardiopulmonary Resuscitation - adverse effects
Cardiopulmonary Resuscitation - methods
Cholecystectomy, Laparoscopic
Combined Modality Therapy
Disseminated Intravascular Coagulation - etiology
Electric Countershock
Epinephrine - therapeutic use
Female
Furosemide - therapeutic use
Heart Arrest - etiology
Heart Arrest - therapy
Hemoperitoneum - etiology
Humans
Intraoperative Complications - chemically induced
Intraoperative Complications - therapy
Middle Aged
Neuromuscular Nondepolarizing Agents - adverse effects
Respiration, Artificial
Splenectomy
Splenic Rupture - etiology
Splenic Rupture - surgery
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Summary:We report the case of a 55-year-old woman ASA 2 scheduled for a cholecystectomy, who presented 25 minutes after the induction, a circulatory arrest probably due to a cardiac anaphylaxis attributed to atracurium. After 60 minutes of futile resuscitation without any spontaneous cardiac rhythm a percutaneous cardiopulmonary bypass (CPB) was initiated. Twenty minutes later and after three external electric shocks electric cardiac activity returned normal. The weaning was possible 120 minutes later with catecholamine support. She left the intensive care unit on postoperative day seven after a laparotomy secondary to splenic injury due to intensive cardiopulmonary resuscitation. She was discharged home without any neurologic or cardiac sequellae. Biological assessment done during the circulatory arrest and cutaneous tests performed ten weeks later confirmed an isolated allergy to atracurium. CPB is the most efficient support in case of reversible cardiac arrest but unfortunately the less accessible outside from cardiac surgery unit.
ISSN:0750-7658
DOI:10.1016/j.annfar.2005.02.008