Journal of Dental Anesthesia and Pain Medicine

The Korean Dental Society of Anesthsiology (대한치과마취과학회)
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Airway anesthesia with lidocaine for general anesthesia without using neuromuscular blocking agents in a patient with a history of anaphylaxis to rocuronium: a case report

  • Ji, Sung-Mi (Department of Anesthesiology and Pain Medicine, Dankook University College of Medicine) ;
  • Song, Jaegyok (Department of Anesthesiology and Pain Medicine, Dankook University College of Medicine) ;
  • Choi, Gunhwa (Department of Anesthesiology and Pain Medicine, Dankook University College of Medicine)
  • Received : 2020.03.14
  • Accepted : 2020.05.19
  • Published : 2020.06.30
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Abstract

We experienced a case of induction of general anesthesia without using neuromuscular blocking agents (NMBAs) in a 40-year-old woman with a history of anaphylaxis immediately after the administration of anesthetics lidocaine, propofol, and rocuronium to perform endoscopic sinus surgery 2 years before. The skin test showed a positive reaction to rocuronium and cis-atracurium. We induced general anesthesia without using NMBAs after inducing airway anesthesia with lidocaine (transtracheal injection and superior laryngeal nerve block). Deep general anesthesia was maintained with end-tidal 4 vol% sevoflurane. Hypotension was treated with phenylephrine infusion. The operation condition was excellent, and patient recovered without complications after surgery. Airway anesthesia with local anesthetics may be helpful when we cannot use NMBAs for any reason, including hypersensitivity to NMBA and surgery that needs neuromuscular monitoring.

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References

  1. Brereton A, Russell WJ. Anaphylaxis to muscle relaxants: an audit of ten years of allergy testing at the Royal Adelaide Hospital. Anaesth Intensive Care 2012; 40: 861-6. https://doi.org/10.1177/0310057X1204000515
  2. Volcheck GW, Hepner DL. Identification and management of perioperative anaphylaxis. J Allergy Clin Immunol Pract 2019; 7: 2134-42. https://doi.org/10.1016/j.jaip.2019.05.033
  3. Jang YH, Kim SG, Son YH, Park JM. Rocuronium bromide induced anaphylaxis in a child -a case report-. Korean J Anesthesiol 2010; 59: 411. https://doi.org/10.4097/kjae.2010.59.6.411
  4. Mertes PM, Lambert M, Gueant-Rodriguez RM, Aimone-Gastin I, Mouton-Faivre C, Moneret-Vautrin DA, et al. Perioperative anaphylaxis. Immunol Allergy Clin North Am 2009; 29: 429-51. https://doi.org/10.1016/j.iac.2009.04.004
  5. Ebo DG, Fisher MM, Hagendorens MM, Bridts CH, Stevens WJ. Anaphylaxis during anaesthesia: diagnostic approach. Allergy 2007; 62: 471-87. https://doi.org/10.1111/j.1398-9995.2007.01347.x
  6. Pedersen AF, Green S, Rose MA. Failure to investigate anaesthetic anaphylaxis resulting in a preventable second anaphylactic reaction. Anaesth Intensive Care 2012; 40: 1053-5. https://doi.org/10.1177/0310057x1204000619
  7. Thacker MA, Davis FM. Subsequent general anaesthesia in patients with a history of previous anaphylactoid/ anaphylactic reaction to muscle relaxant. Anaesth Intensive Care 1999; 27: 190-3. https://doi.org/10.1177/0310057X9902700212
  8. Fisher MM, Bowey CJ. Intradermal compared with prick testing in the diagnosis of anaesthetic allergy. Br J Anaesth 1997; 79: 59-63. https://doi.org/10.1093/bja/79.1.59
  9. Des Roches A, Paradis L, Bougeard YH, Godard P, Bousquet J, Chanez P. Long-term oral corticosteroid therapy does not alter the results of immediate-type allergy skin prick tests. J Allergy Clin Immunol 1996; 98: 522-7. https://doi.org/10.1016/S0091-6749(96)70085-4
  10. Rajan S, Mathew J, Tosh P, Sudevan M. Safety of inhalational anesthesia in patients with multiple drug allergies presenting for major surgeries under general anesthesia. Anesth Essays Res 2019; 13: 259-63. https://doi.org/10.4103/aer.AER_28_19
  11. Ono AH, Moura TR, Goveia CS, Guimaraes GMN, de Araujo Ladeira LC, da Silva HBG. ED50 of remifentanil for providing excellent intubating conditions when co-administered with a single standard dose of propofol without the use of muscle relaxants in children: dosefinding clinical trial. J Anesth 2018; 32: 493-8. https://doi.org/10.1007/s00540-018-2502-z
  12. Abdelhalim AA, Maghraby HH, ElZoughari IA, AlZahrani TA, Moustafa MS, Alfassih KM, et al. Using fentanyl and propofol for tracheal intubation during sevoflurane induction without muscle relaxants in children: a randomized prospective study. Saudi J Anaesth 2017; 11: 312-8. https://doi.org/10.4103/1658-354X.206802
  13. Wei L, Deng X, Sui J, Wang L, Liu J. Dexmedetomidine improves intubating conditions without muscle relaxants in children after induction with propofol and remifentanil. Anesth Analg 2015; 121: 785-90. https://doi.org/10.1213/ANE.0000000000000812
  14. Rajan S, Puthenveettil N, Paul J. Transtracheal lidocaine: an alternative to intraoperative propofol infusion when muscle relaxants are not used. J Anaesthesiol Clin Pharmacol 2014; 30: 199-202. https://doi.org/10.4103/0970-9185.130016