thiopental and Cyanosis

A 6-year-old boy presented for surgery for phimosis. The anaesthetic technique included intravenous induction with thiopentone and neuromuscular blockade with cisatracurium. Severe persistent bronchospasm and central cyanosis followed the administration of these drugs. A continuous i.v. infusion of epinephrine at 0.2 microg. kg(-1) x min(-1) was necessary to break the severe refractory bronchial hyperresponsiveness. There was no previous exposure to anaesthetic drugs and no definite family history of allergy. Through increased serum eosinophil cationic protein, tryptase and histamine levels and IgE levels specific to cisatracurium, we demonstrated an IgE-mediated anaphylactic reaction to cisatracurium in the child's first exposure to this new neuromuscular blocking agent. Anaphylactic reactions to new anaesthetic drugs may be challenging to recognize and treat during general anaesthesia in children. The pathogenesis, diagnosis and management of life threatening persistent allergic reactions to intravenous anaesthetics are discussed.

Topics: Adrenergic Agonists; Anaphylaxis; Anesthetics, Intravenous; Atracurium; Blood Proteins; Bronchial Hyperreactivity; Bronchial Spasm; Child; Chymases; Cyanosis; Eosinophil Granule Proteins; Epinephrine; Histamine; Humans; Immunoglobulin E; Inflammation Mediators; Male; Mast Cells; Neuromuscular Blockade; Neuromuscular Blocking Agents; Phimosis; Ribonucleases; Serine Endopeptidases; Thiopental; Tryptases

Topics: Adolescent; Adult; Aged; Alfaxalone Alfadolone Mixture; Anesthesia, Intravenous; Anesthetics; Child; Child, Preschool; Cyanosis; Drug Hypersensitivity; Female; Humans; Male; Middle Aged; Retrospective Studies; Thiopental

Two cases are described and discussed in which penicillin powder applied to the theca at the end of laminectomy caused delayed convulsions.

Topics: Adult; Cyanosis; Diazepam; Female; Humans; Intermittent Positive-Pressure Breathing; Middle Aged; Oxygen; Penicillins; Postoperative Complications; Seizures; Spinal Cord; Surgical Wound Infection; Thiopental

A case is reported in which a major generalised convulsive seizure followed the administration of Althesin. The patient had no clinically demonstrable predisposition to epilepsy. The fits were rapidly controlled by the intravenous injection of thiopentone.

Topics: Adult; Anesthetics; Cyanosis; Drug Combinations; Female; Humans; Hydroxysteroids; Oxygen; Pregnanediones; Seizures; Thiopental

Topics: Adult; Blood Pressure; Central Nervous System; Cyanosis; Gallamine Triethiodide; Heart Rate; Herniorrhaphy; Humans; Injections, Spinal; Male; Oxygen; Pulse; Seizures; Sweating; Thiopental

Topics: Adult; Anesthesia, Inhalation; Anesthesia, Intravenous; Atropine; Biopsy; Blood Pressure; Body Temperature; Creatine Kinase; Cyanosis; Heart Rate; Hiccup; Humans; Ice; Male; Malignant Hyperthermia; Muscles; Postoperative Care; Procainamide; Succinylcholine; Thiopental; Tubocurarine; Vagotomy

Topics: Anesthesia, Inhalation; Ascorbic Acid; Blood Gas Analysis; Cyanosis; Female; Hemoglobins; Humans; Methemoglobin; Methemoglobinemia; Methylene Blue; Middle Aged; Nitrous Oxide; Spectrum Analysis; Thiopental; Tubocurarine

Topics: Adult; Anaphylaxis; Anesthesia, Intravenous; Cyanosis; Drug Hypersensitivity; Female; Humans; Tachycardia; Thiopental

Topics: Adult; Aminophylline; Anesthesia, General; Bronchial Spasm; Cyanosis; Cystoscopy; Drug Hypersensitivity; Female; Humans; Hydrocortisone; Hypotension; Male; Middle Aged; Tachycardia; Thiopental

Topics: Acidosis; Adenosine Triphosphate; Anesthesia, General; Animals; Cyanosis; Fever; Halothane; Hyperventilation; Muscles; Oxygen; Prognosis; Sodium; Swine; Tachycardia; Thiopental

Topics: Anesthesia, General; Bradycardia; Cholecystectomy; Cyanosis; Female; Humans; Hypotension; Middle Aged; Pneumothorax; Radiography; Succinylcholine; Thiopental

Topics: Analysis of Variance; Anesthesia, General; Apnea; Arrhythmias, Cardiac; Blood Specimen Collection; Bronchoscopy; Carbon Dioxide; Catheterization; Cyanosis; Female; Humans; Hypercapnia; Hyperventilation; Lidocaine; Male; Middle Aged; Oxygen; Oxygen Consumption; Positive-Pressure Respiration; Succinylcholine; Thiopental; Vocal Cords

Topics: Aged; Autonomic Nerve Block; Cyanosis; Edema; Hand; Hibernation; Humans; Hypothermia, Induced; Injections; Injections, Intra-Arterial; Injections, Intravenous; Pharmacology; Procaine; Spasm; Stellate Ganglion; Thiopental; Thrombophlebitis; Toxicology