sultamicillin and Anaphylaxis

Although reversible H2 receptor antagonists are usually well tolerated, there are few reports on anaphylactic reactions triggered by ranitidine. Here we report the first case of anaphylaxis to ranitidine in a child. This was an IgE-mediated event occurring in a patient who had never used ranitidine before.

Topics: Administration, Intravenous; Ampicillin; Anaphylaxis; Anti-Bacterial Agents; Anti-Ulcer Agents; Child; Cholecystitis, Acute; Humans; Male; Ranitidine; Sulbactam

We report a case of anaphylactic shock induced by an antibiotic administrated after induction. A 39-year-old man was scheduled for removal of right adrenal tumor. After insertion of an epidural catheter, anesthesia was induced with an intravenous bolus injection of fentanyl 100 microg, propofol 130 mg and vecuronium 6 mg. The trachea was intubated smoothly and anesthesia was maintained with sevoflurane. Sultamicillin tosilate was administrated intravenously. Soon, ephedrine 12 mg was given intravenously because his blood pressures decreased. However, his blood pressure did not recover, but fell down to 35/22 mmHg. He was turned to head-down position, and 100% oxygen was administrated. Following epinephrine 0.1 mg injection, his blood pressure increased to 80/40 mmHg. Epinephrine at 0.005-0.02 microg x kg(-1) x min(-1) was infused continuously to maintain his blood pressure. We found erhythemia on his face, shoulders and arms. Hydrocortisone sodium succinate and acetate Ringer's solution were administrated to treat his anaphylactic shock and the surgery was postponed. The blood samples indicated that this event was IgE-mediated anaphylactic reaction. From his past history, penicillin allergy was confirmed. The surgery was rescheduled and anesthesia was managed in the same way as previous one. Surgery was successfully performed using levofloxacin, which had been taken orally before induction of anesthesia.

Topics: Adrenal Gland Neoplasms; Adrenalectomy; Adult; Ampicillin; Anaphylaxis; Anesthesia, Epidural; Anesthesia, General; Anti-Bacterial Agents; Biomarkers; Histamine; Humans; Infusions, Intravenous; Intraoperative Care; Male; Sulbactam; Tryptases

A 63-year-old woman presented with an exacerbation of her chronic obstructive pulmonary disease. While receiving an infusion of ampicillin/sulbactam, she developed anaphylaxis-induced myocardial injury. Subsequent coronary angiography revealed minimal atherosclerosis of her coronary arteries. The patient remained under continuous observation and cardiac monitoring throughout her reaction, thus providing unique insight into the pathophysiology of myocardial injury caused by anaphylaxis. The medical literature that pertains to this phenomenon is discussed.

Topics: Aged; Ampicillin; Anaphylaxis; Cardiac Catheterization; Cardiomyopathies; Coronary Disease; Drug Therapy, Combination; Electrocardiography; Female; Humans; Sulbactam