Life-threatening isosulfan blue induced anaphylaxis during laparoscopic hysterectomy

Abstract

The use of blue dye alone is the first described technique for sentinel lymph node (SLN) identification in patients with cervical carcinoma. In this procedure, Isosulfan Blue (IB), Methylene Blue or Patent Blue is injected into each quadrant of the cervix. We present an anaphylactic reaction to IB in a patient who underwent a laparoscopic hysterectomy. Approximately 15 min after the dye injection, the patient developed hypotension (55/35 mmHg) with an increase in heart rate (120 beats/minute) and a decrease of pulse oximetry to 85%. She was treated successfully with ephedrine, adrenaline, and fluid administration. When sterile drapes were removed, blue urticarial rashes all over the body were detected. The operation was halted, and the patient was transferred to the intensive care unit (ICU). Almost 4 hours after injection of IB, she experienced a second attack of bronchospasm under mechanical ventilation. She recovered uneventfully and was discharged from the ICU. The patient was referred to a skin prick test which was positive for IB. SLN biopsy for cervical cancers may have an increased risk of anaphylaxis probability due to administered blue dyes. It is crucial that the medical staff involved in these procedures be aware of anaphylactic reactions. This case report highlights the necessity of close monitoring of these patients in both the intraoperative and postoperative periods.

Keywords

• Anaphylaxis,Sentinel lymph node,Hysterectomy,Isosulfan blue

Laparoskopik histerektomi ameliyatı sırasında gelişen izosulfan mavisi ilişkili hayatı tehdit eden anafilaksi

Öz

Tek başına mavi boya kullanımı servikal karsinomlu hastalarda sentinel lenf nodu (SLN) tanımlaması için ilk tarif edilen tekniktir. Bu prosedürde, serviksin her çeyreğine İzosulfan Mavisi (İM), Metilen Mavisi veya Patent Mavisi enjekte edilir. Biz bu olguda laparoskopik histerektomi uygulanan bir hastada İM’ye karşı gelişen anafilaktik bir reaksiyonu sunduk. Boya enjeksiyonundan yaklaşık 15 dakika sonra hastada kalp atım hızında artış (120 atım / dakika) ve nabız oksimetresinde %85'e varan bir azalma ile hipotansiyon (55/35 mmHg) gelişti. Hasta, efedrin, adrenalin ve sıvı uygulaması ile başarılı bir şekilde tedavi edildi. Steril örtüler açıldığında, vücudun her yerinde mavi ürtiker döküntüleri tespit edildi. Operasyon durduruldu ve hasta yoğun bakım ünitesine (YBÜ) transfer edildi. Hasta İM'nin enjeksiyonundan yaklaşık 4 saat sonra, mekanik ventilasyon altında ikinci bir bronkospazm atağı yaşadı. Hasta sorunsuz bir şekilde iyileşti ve yoğun bakımdan taburcu edildi. Hasta, İM için pozitif olan bir deri testine yönlendirildi. Servikal kanserler için SLN biyopsisi, uygulanan mavi boyalara bağlı olarak artmış anafilaksi riski taşıyabilir. Bu prosedürlere dahil olan tıbbi personelin anafilaktik reaksiyonlara karşı dikkatli çok önemlidir. Bu olgu sunumu, bu hastaların hem intraoperatif hem de postoperatif dönemde yakından izlenmesinin gerekliliğini vurgulamaktadır.

Anahtar Kelimeler

• Anafilaksi,Sentinel lenf nodu,Histerektomi,İzosulfan mavisi

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