Asploro Journal of Biomedical and Clinical Case Reports
Article Type: Case Report
Asp Biomed Clin Case Rep. 2023 Jul 03;6(2):168-74
Corresponding Author: Wei Wei
Address: Department of Anesthesiology, West China Hospital, Sichuan University, No. 37 Guo Xue Xiang, Chengdu 610041, Sichuan, China.
Received date: 09 June 2023; Accepted date: 26 June 2023; Published date: 03 July 2023
Citation: Xiong X, Wei W. Catecholamine-Refractory Anaphylactic Shock to Vecuronium in a Patient with Tetralogy of Fallot: A Case Report. Asp Biomed Clin Case Rep. 2023 Jul 03;6(2):168-74.
Copyright © 2023 Xiong X, Wei W. This is an open-access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium provided the original work is properly cited.
Keywords: Anaphylactic Shock, Vecuronium, Tetralogy of Fallot, Cardiopulmonary Bypass, Symmetrical Peripheral Gangrene
Abbreviations: NMBDs: Neuromuscular Blocking Drugs; TOF: Tetralogy of Fallot; CPB: Cardiopulmonary Bypass; SpO2: Pulse Oxygen Saturation; ECG: Electrocardiogram; SBP: Systolic Blood Pressure; ETCO2: End-Tidal Carbon Dioxide; TEE: Trans Esophageal Echocardiography; MAP: Mean Arterial Pressure; DIC: Disseminated Intravascular Coagulation
Serious anaphylactic reactions to anesthetics can be life-threatening events. Vecuronium is promoted as a neuromuscular blocking drug that is least likely to cause anaphylaxis due to its low histamine-releasing potential. Perioperative hypoxemia in patients with tetralogy of Fallot (TOF) due to anaphylactic reactions can be easily misdiagnosed as anoxic spells. We report a patient with TOF who suffered from symmetrical peripheral gangrene after undergoing catecholamine-refractory anaphylactic shock to vecuronium perioperatively. CPB (cardiopulmonary bypass) is the most effective support for severe anaphylactic shock during the perioperative period. Intradermal test screening for anaphylaxis to anesthetics is an effective method for prevention and diagnosis.