Management of a Case Developing Resistant Anaphylactic Shock in Hydatid Cyst Surgery

2. SBÜ Uluslararası Katılımlı Anesteziyoloji ve Reanimasyon Sempozyumu, Ankara, Türkiye, 2 - 03 Aralık 2022, ss.93

INTRODUCTION - PURPOSE: One of the common complications of a hydatid cyst is

rupture of the cyst during surgery or after trauma. Rupture can cause allergic reactions,

anaphylactic shock, or even death. We aimed to share the management of resistant anaphylactic

shock in a patient with pacemaker.

CASE: The patient with pacemaker due to a complete atrioventricular block underwent

laparoscopic surgery due to a hydatid cyst in the liver. Sudden hypotension developed at the

55th minute of surgery. The surgical team reported that they only injected hypertonic saline

and there was no leakage in the surgical area. Lung sounds were normal and airway pressures

were within normal limits. Considering that there may be a problem with the pacemaker, the

magnet was removed but the hypotension did not improve. The surgical procedure was stopped,

the patient was placed in a head-down position, and ephedrine was administered. Five minutes

later, rashes developed on the trunk; diffuse lung wheezing, elevated airway pressure, and

desaturation were observed. Repeated intravenous adrenaline was administered (10, 20, and

50μg, respectively) and rapid fluid infusion was started. Methylprednisolone, pheniramine,

salbutamol, and aminophylline were given due to continued widespread wheezing. Blood

pressure increased to 110/70mmHg in 25minutes after all interventions. Laparotomy was

performed and cystectomy was completed.

DISCUSSION - CONCLUSION: Intraoperative sudden hypotension can be caused by many

different pathologies such as hemorrhagic shock, acute myocardial infarction, anaphylactic

shock, pulmonary embolism, and complications of laparoscopic surgeries. In this case, the

initial presentation with sudden hypotension and the late appearance of skin rashes and

respiratory symptoms made the differential diagnosis difficult. The presence of pacemaker

prevented to evaluate ST segment analysis and tachy-bradycardia. In conclusion, it should be

considered that an anaphylactic reaction may develop without significant macroscopic rupture,

and diagnosis and treatment may be difficult in complex patients.

Keywords: Anaphylaxis, Anaphylactic Shock, Hydatid Cyst, Resuscitation