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Anaphylactic-like reaction to methylene blue: case report and review of perioperative hypersensitivity reactions.

Abstract：

BACKGROUND:Anaphylaxis and anaphylactic-like reactions in the perioperative period are a significant concern for anesthesiologists and surgeons. With an incidence as high as one in 3500 and a mortality rate of 3 to 6 percent, proper management of these reactions is essential. The available surgical literature provides varied and unclear guidelines for determining the nature of these reactions and has no consensus treatment algorithm. The authors present a rare case of hypersensitivity reaction to methylene blue during cleft lip repair. A review of current literature for best-practice evaluation and management guidelines follows. METHODS:Literature review was performed using search terms including "anaphylaxis," "hypersensitivity," "allergy," "perioperative," and "intraoperative." Results from basic science literature, case reports, and clinical studies were used, as were personal communications with leading investigators in allergy and immunology. RESULTS:Despite variations in incidence, reporting, evaluation, and management, the authors found that immediate treatment should include epinephrine, steroids, and histamine-1- and histamine-2-blocking agents. In the event of reactions with characteristics of anaphylaxis, obtaining tryptase levels 1, 4, and 24 hours after the event provides the most accurate biochemical evidence. Skin-prick and intradermal testing by an allergy specialist should be performed 6 or more weeks after the reaction. CONCLUSIONS:With the unique exposure risks in the perioperative period, it is the surgeon's responsibility to aid in the proper immediate and short-term treatment of anaphylaxis and anaphylactic-like reactions. Proper biochemical evaluation at the time of reaction can be critical in helping the patient avoid future reactions and should not be overlooked. CLINICAL QUESTION/LEVEL OF EVIDENCE:Therapeutic, V.

journal_name

Plast Reconstr Surg

journal_title

Plastic and reconstructive surgery

authors

Giladi AM,Kasten SJ

doi

10.1097/PRS.0b013e318254b2b8

subject

Has Abstract

pub_date

2012-07-01 00:00:00

pages

98e-105e

issue

eissn

0032-1052

issn

1529-4242

pii

00006534-201207000-00034

journal_volume

130

pub_type

杂志文章

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Anaphylactic-like reaction to methylene blue: case report and review of perioperative hypersensitivity reactions.