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My dad met with an accident few days ago. By God’s grace he wasn't badly injured however, he got some bruises and light scratch marks on his bilateral knees and his elbow region. He is doing much better now. My mother is a nurse and she gave my dad some pain killers and antibiotics. My dad took few Dan P and 1 or 2 painkillers. I got to know today that my dad has developed some allergic reaction leading to continuous itchiness along with some mild headache. Thank god my dad got a check-up and now he is perfectly fine. The doctor told because my dad had eggplant the other day (it is rare though) but Dan P has a tendency to interact with some food and this might have cause the itchy reaction. Thinking about this case I accidently came across an article regarding the allergic reaction and anaphylaxis. We have normally heard of people getting allergic reactions to food, seasonal or sometimes pollen. Few of my friends have also allergic reactions by taking 2 different kinds of food items simultaneously. But all this allergic reactions are not that severe and can be tackled by 1 or 2 doctor’s visit. Anaphylaxis or anaphylactic reactions on the other hand are more dangerous and deadly in nature. Anaphylactic reactions are usually the whole-body reactions to allergens, chemicals and sometimes snake venom. When the person comes in contact with the allergens, eventually the person’s immune system gets sensitized. When the person again comes in contact with this allergens immune system produces a reaction which is severe and more fatal and is anaphylactic shock. Today I was searching though PubMed and I found some very interesting articles. Anaphylactic shock is devastating and can cause multi-organ failure at the same time. No wonders but anaphylactic shock can result in death without any reason. Below are the list of some interesting articles that explain the death after surgery (anesthesia) and some medications that are the reason for anaphylaxis. 1)The first and rare anaphylaxis reaction was noted when patient was given micro emulsion propofol during anesthesia (Lee, Kim, Jung, Lee, Kim, Park, Kim & Ok, 2012). Lee et al. (2012), states that Aquafol produced by the Daewon Pharmaceuticals, is a micro emulsion propofol and was developed to eliminate lipid solvent-related adverse events, and was used in clinical anesthesia since 2009 with little data about severe side effects such as anaphylaxis. The case that was put forward by Lee et al. (2012) is very interesting. A healthy 16-yr-old male patient who had past medical history with two previous operations of no complications developed cardiovascular shock with generalized erythema following administration of microemulsion propofol during anesthesia induction. Intravenous injection of epinephrine and steroid rescued him. He remained in a stable state without any problems postoperatively and was discharged. Clinicians should consider this rare but serious complication during induction of anesthesia with propofol. 2)The second interesting case of bronchospasm and anaphylactic shock was observed in the patient following Lidocaine Aerosol Inhalation in butane inhalation lung surgery (Lee, Park, Yeo, Kim, Goong, Jang & Park, 2011). Here is the case study: A 54-year-old man was admitted to the hospital in the winter because of shortness of breath. The patient reportedly had an inhalation lung injury due to butane gas fuel. On the fifth day, he developed an asthmatic attack and anaphylactic shock immediately after Lidocaine aerosol administration to prepare for bronchoscopy to confirm an acute inhalational lung injury diagnosis. Cardiopulmonary resuscitation was performed immediately after respiratory arrest, and the patient was admitted to the intensive care unit intubated and on a ventilator. He was extubated safely on the third post-cardiopulmonary resuscitation day. These observations suggest that aerosol Lidocaine anesthesia may cause airway narrowing and anaphylactic shock. Practitioners should be aware of this potential complication. We report on this case with a brief review of the literature. 3)The third case was noted by Omidi (2009). The case involved anaphylactic shock in a cow due to parenteral administration of penicillin-streptomycin. Here is the case study by Omidi (2009): Anaphylactic reaction rarely occurs after the 1st injection of penicillin-streptomycin in cattle. Immediately following intramuscular injection of a Holstein-Friesian cow with penicillin-streptomycin, the cow showed abnormal clinical signs that included respiratory distress, urticaria, and lacrimation. Recovery took approximately 2 h after intramuscular injection of dexamethasone. This report presents clinical findings recorded 20 and 40 h later. 4) The fourth case was noted by Lee, Choi, Lee and Nahm (2011). The study reports the anaphylactic shock caused by epidurally –administered hyalurinidase. Hyalurinidase is a substance which is mainly used as anesthesia in ocular, dental and plastic surgery (lee et al., 2011). Case Study 1: Here the patient had low back pain with numbness in the lower extremity. The patient was diagnosed of a post-laminectomy syndrome and the patient was given epidural hyalurinidase to perform the real time fluoroscopic imaging. 5)The fifth case study is presented by Miraj, Foaud & Seth (2010). The study notes cardiac arrest in a 58-year-old woman following anaphylactic reaction to atracurium. Here is the case study: A 58-year-old woman who was scheduled for sub acromial decompression of right shoulder joint. She had a modified rapid sequence induction using fentanyl 100 µg, propofol 150 mg and suxamethonium 100 mg. Following induction her blood pressure and pulse were stable. On return of spontaneous ventilation, she had intravenous administration of 30 mg of atracurium. Soon after, she developed profound bradycardia followed by a cardiac arrest. Cardiopulmonary resuscitation (CPR) commenced with 100% oxygen and intravenous administration of atropine 3 mg and epinephrine 1 mg. After 1 min of CPR she had the return of spontaneous circulation with a blood pressure of 160/100 mm Hg. Her sedation was maintained using minimal isoflurane until the return of spontaneous ventilation to avoid awareness. Surgery was postponed. Later she made an uneventful recovery. Her serum tryptase level was raised and a positive intradermal reaction to atracurium confirmed atracurium anaphylaxis (The entire case study reproduced from the article of Miraj et al., 2010). 6)The last article I found states about the anaphylactic reaction to intravenous diclofenac sodium (Singh, Bansal, Baduni & Vajifdar, 2011). Diclofenac sodium is a non-steroidal anti-inflammatory drug from the drug class of opioids. Singh et al. (2011) reports a case of a 25-year-old primigravida female was admitted with complaints of severe pain in the abdomen for 2 days and bleeding per vaginum for 1 day. When the patient arrived, she was drowsy, with a pulse rate (PR) of 150/minute, blood pressure (BP) of 84/56 mmHg, and SpO2 on air was 95%. She was diagnosed to have ruptured ectopic pregnancy and taken up for an emergency exploratory laparotomy. In view of excessive blood loss (3.0 l), she was shifted to Intensive Care Unit (ICU) postoperatively for elective ventilation. After 12 hours, the patient’s trachea was extubated. At that time, the vital parameters were PR 108/minute, BP 112/84 mmHg and SpO2 on air 100%. Four hours after extubation, IV diclofenac 75 mg was started in 100 ml of normal saline for postoperative analgesia. About 20-25 minutes after starting the infusion, the patient complained of tightness in her chest, palpitations and shortness of breath. Her saturation dipped to 55% on air, which increased to 72% on administering oxygen (FiO2 of 1.0), PR was 183/minute, BP was 80/40 mmHg, and respiratory rate (RR) was 40/minute. On examination, extremities were cold and auscultation of chest revealed bilateral ronchi. Her arterial blood gases demonstrated pH 7.47, pO2 32 mm of Hg, pCO2 37 mm Hg (Type I respiratory failure) {The entire case study is reproduced from the article written by Singh et al., 2011). Thank you Sweta
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