Cas clinique
Chocs anaphylactiques après levée de garrot en chirurgie orthopédiqueAnaphylactic shocks following tourniquet release in orthopaedic surgery

https://doi.org/10.1016/0750-7658(96)85039-8Get rights and content

Résumé

Sont rapportées les observations de six patients ayant eu des symptômes de choc anaphylactique sévère après levée de garrot, en fin d'intervention orthopédique mineure sous anesthésie locorégionale. Le mécanisme immunologique du choc a été confirmé par des tests allergologiques cutanés (prick tests). L'agent causal était la rifamycine SV, utilisée pour le nettoyage de la plaie opératoire avant sa fermeture. En cas de chirurgie répétitive et/ou chez les patients allergiques, le recours à un autre antibiotique ou le simple nettoyage à l'aide de soluté salé isotonique doit être considéré. En cas de chirurgie sous garrot, l'accès veineux doit être maintenu pendant l'heure suivant la levée de celui-ci et le patient admis en salle de surveillance postinterventionnelle. Le bilan allergologique doit être effectué 3 à 6 semaines plus tard et porter sur l'ensemble des agents administrés par voies générale et locale pendant les 10 minutes précédant la survenue du choc.

Abstract

Case report of six patients who experienced symptoms of severe anaphylactic shock, after tourniquet release at the end of minor orthopaedic surgery of the limbs under regional anaesthesia. The immunological mechanism of the shock was confirmed by prick tests. The causative agent was rifamycin SV used for cleaning the surgical wound prior to its closure. In case of repetitive surgery and/or in allergic patients the use of another antibiotic or the simple cleaning of the wound with normal saline should be considered. In case of surgery using a tourniquet, an iv access should be maintained for 1 hour after tourniquet release and the patient closely monitored in the recovery room. The allergologic assessment should take place 3 to 6 weeks later and include all drugs administered during the 10 minutes preceding the occurrence of shock.

Références (8)

There are more references available in the full text version of this article.

Cited by (22)

  • The influence of rifamycin decontamination on incorporation of autologous onlay bone grafts in rats: A histometric and immunohistochemical evaluation

    2015, Archives of Oral Biology
    Citation Excerpt :

    It is extremely rare for side effects to occur after the local administration of rifamycin. Very rarely, anaphylactic reactions have been reported after the application of rifamycin SV.13,17 In our study, no side effects resulting from the rifamycin solution were observed.

  • Local and general anesthetics immediate hypersensitivity reactions

    2014, Immunology and Allergy Clinics of North America
    Citation Excerpt :

    However, reactions may be delayed up to 4 hours when a labile blood product is incriminated.25 Reactions resulting from infiltration of dyes26,27 or of mucous membrane or skin exposure to latex or disinfectants tends to lead to reactions of slower onset.28–30 The clinical diagnosis is presumptive, although essential, because anaphylaxis may progress within minutes to become life threatening.

  • Tourniquet use in civil and military medicines

    2014, Annales Francaises d'Anesthesie et de Reanimation
  • Allergic risk in anaesthesia

    2013, Presse Medicale
  • Perioperative Anaphylaxis

    2010, Medical Clinics of North America
    Citation Excerpt :

    Particles from obstetricians' gloves, which accumulate in the uterus during obstetric maneuvers, could suddenly be released into the systemic blood flow following oxytocin injection.11 Anaphylactic reactions to antibiotics have also been reported following removal of tourniquet during orthopedic surgery.34 During an IgE-mediated reaction, basophils and mast cells are activated, then degranulate and release mediators into the extracellular fluid compartment.

View all citing articles on Scopus
View full text