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REGIONAL ANESTHESIA AS AN ALTERNATIVE FOR A PATIENT ALLERGIC TO MUSCLE RELAXANTS - A CASE STUDY
Author(s): ,
Mihaljević , L.
Affiliations:
Clinical Hospital Center Zagreb, Department for Anaesthesiology and Intensive Care Medicine- Clinic for Obstetrics and Gynecology, Zagreb, Croatia
,
Krešimir , R.
Affiliations:
Clinical Hospital Center Zagreb, Department for Anaesthesiology and Intensive Care Medicine- Clinic for Obstetrics and Gynecology, Zagreb, Croatia
,
Mihaljević , S.
Affiliations:
Clinical Hospital Center Zagreb, Department for Anaesthesiology and Intensive Care Medicine- Clinic for Obstetrics and Gynecology, Zagreb, Croatia
Fuduric, S.*
Affiliations:
Clinical Hospital Center Zagreb, Department for Anaesthesiology and Intensive Care Medicine- Clinic for Obstetrics and Gynecology, Zagreb, Croatia
ESRA Academy. Fuduric S. Sep 13, 2017; 190692
Sandra Fuduric
Sandra Fuduric

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Abstract
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Background and Aims:

A 29 year old female patient suffered anaphylactic reaction at the induction of general anesthesia for elective surgery. 

Methods:

A patient with a diagnose of right ovarian cyst was classified as ASA 1 and scheduled for laparoscopic surgery. For the induction of general anesthesia, the patient was given intravenously 2 mg of midazolam, 150 mcg of fentanyl, 350 mg of thiopental and 40 mg of rocuronium. Immediately after endotracheal intubation, patient developed generalized macular rash, followed by unmeasurable blood pressure and tachycardia up to 150 bpm. 1000 ml of crystalloid in a fast bolus, 1 mg of adrenalin, 20 mg of chloropyramine and 125 mg of methylprednisolone were applied intravenously. After haemodynamic stabilisation, decision was made to postpone the procedure until allergologic testing is carried out. The patient had uneventful emergence and was extubated after 45 minutes. 

Results:

Allergology testing showed that the patient was allergic to rocuronium, vecorunium and atracurium. Decision was made to perform surgery by the low abdominal incision under combined spinal-epidural anesthesia. Epidural space was detected with the 16 G epidural needle. Spinal anesthesia was applied with a 27 G needle at the L3-4 interspace and 15 mg of hyperbaric levobupivacaine + 20 mcg of fentanyl was given intrathecally. Epidural catheter was placed and 0.1% levobupivacaine + 5 mcg/ml of fentanyl 2-5 ml/h were administered postoperatively for analgesia. The procedure was unventful as well as the postoperative period.

Conclusions:

Combined spinal-epidural anesthesia is a suitable option for a patient undergoing low abdominal laparatomy.  

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