Márquez AMP, Huerta LJG, Gutiérrez HA, Del Olmo TH

Language: Spanish
References: 6
Page: 34-35
PDF size: 148.01 Kb.

ABSTRACT

Aprotinin is a protein of bovine origin. In recent studies, it has been observed that reexposure to aprotinin after three months is associated with anaphylactic reactions in a percentage of 2.8%. This paper reports the case of patient suffering from anaphylaxis at the second exposure to this drug. The patient was from the male sex, being 13 years old, and with a record of recurrent juvenile nasopharyngeal, he had four relapses with their subsequent collateral resections, and presented diverse collateral complications at the last resection. On the 25^th of July 2007, the patient was practiced a resection of angiofibroma relapse, and Aprotinin is used 2,600,000 IU/IV during the transoperative period, without any complication. On the February 12^th 2008, it is scheduled the fouth post embolization resection, with the administration of 2 mg of intravenous Midazolam in order to achieve the induction. It was also administrated 150 mg of fentanyl, 70 mg of lidocaine. 160 mg of proponyl, and 6 mg of Vecuronium. After placing the central venous subclavian catheter though the site where the Aprotinin infusion was performed in order to achieve the embolization, it was immediately observed pletismography flattering and curvatura of the artery line, desaturation up to the 60%, serious cyanosis, and marbled skin. Fentanyl, Aprotinin and halogenide infusion was suspended, instead salbutamol is administered in three doses of 100 µg each. This last practice gradually improved the patient’s condition. Then it is administered 1 g of metilprednisolone, 8 mg of dexamethasone, and 20 mg of chloropyramine, with refractory hypotension. This report warns us about anaphylactic reactions that Aprotinin may produce in some patients.

REFERENCES

1. Diefenbach C et al. Fatal anaphylactic schock after aprotinin reexposure in cardiac surgery. Anest Analg 1995; 80: 830-1.

2. La Feria G. Anaphylactic reaction to aprotinin despite negative ocular sensitivity test. British Medical Journal 1984: 289.

3. Levy A. Inusual reaction to trasylol setter. CMA Journal 1974: 21.

4. McMahan MJ. Anaphylactic reaction to aprotinin letter. British Medical Journal 1984: 289.

5. Williams S et al. Vasopressin for treatment of schock following aprotinin administration. Canadian Journal of Anestesia 2004; 51(2): 169-172.

6. Toshihiro S. Anaphylaxis to aprotinin in fibrin sealent. Interna Medicine 2005; 44: 1088-1089.