A case report of anaphylactic shock induced by tetracaine used for spinal anesthesia
Moriwaki, K.; Higaki, A.; Sasaki, H.; Murata, K.; Sumida, T.; Baba, I.
Masui. Japanese Journal of Anesthesiology 35(8): 1279-1284
1986
ISSN/ISBN: 0021-4892 PMID: 3783923 Document Number: 268553
Anaphylactic shock induced by spinal anesthetic agents is extremely rare complication of spinal anesthesia. However, once it occurs, it is often life threatening. We report a case of anaphylactic shock induced by tetracaine used for spinal anesthesia in a 34-year-old male patient. The patient, who had been complaining of low back pain and gait disturbance, was diagnosed as having spondylolisthesis of L5 and scheduled for anterior spinal fusion of L 5-S. He had a history of mild allergic rhinitis, but otherwise had been quite healthy. Spinal anesthesia was performed using hyperbaric tetracaine solution with phenylephrine. After the surgery began, severe respiratory and circulatory problems, including difficult ventilation, bronchospasm, laryngeal edema and circulatory collapse, were encountered. Trachea was intubated and 100% oxygen was given. At that time, sweating, goose-skin, erythema and edema were observed on the whole body surface. Anaphylactic shock was suspected, and standard therapy for anaphylactic shock, such as, fluid transfusion, administration of epinephrine, methylprednisolone, aminophyllline and etc., were initiated and the symptoms were relieved gradually. The patient was, then, managed with general anesthesia and the surgery was performed successfully. A month later, in order to identify the drug which caused anaphylactic shock in this case, skin tests, which included prick test, intradermal test and Prausnitz-Kustner reaction, were performed. The results showed that tetracaine used for spinal anesthesia was the agent which caused the shock in this patient.