التفاصيل البيبلوغرافية
| العنوان: |
Severe Airway Edema Due to Tranexamic Acid and Albumin Transfusion. |
| المؤلفون: |
Kazbek, Baturay Kansu1, Köksoy, Ülkü Ceren2, Ekmekçi, Perihan2, Tüzüner, Filiz2 |
| المصدر: |
Journal of Anesthesia / Anestezi Dergisi (JARSS). 2023 Special Issue, Vol. 31, p171-171. 1p. |
| مصطلحات موضوعية: |
*TRYPTASE, *TRANEXAMIC acid, *JOINT infections, *ALBUMINS, *RUBBER, *PREOPERATIVE period, *EDEMA |
| مستخلص: |
Background: The incidence of life threatening anaphylactic reactions is between 1:353 and 1:18,600. Although tranexamic acid and albumin have a high margin of safety, allergic reactions to both agents have been reported. We describe a severe and life threatening upper airway edema in a patient in whom tranexamic acid and albumin infusions were given simultaneously. Case: A 79 years-old ASA-II male patient who underwent debridement due to periprosthetic infection following hip arthroplasty was given albumin and tranexamic acid infusions in the surgical ward. The patient complained of dyspnea and physical examination revealed severe edema of the tongue, perioral area and chin (Figure 1,2). The infusions were stopped and the patient was given nebulization therapy, diphenhydramine (45.5 mg iv), methylprednisolone (total 240 mg iv) and pantoprazole (40 mg iv). Rapid intubation in the operating room was planned as the patient deteriorated. Videolaryngoscopy for a possible difficult ventilation failed. Inotrope infusions were initiated due to hemodynamic instability. The patient was intubated with a 6.0 endotracheal tube using Fastrach LMA, which was exchanged with a 7.5 endotracheal tube using a gum elastic bougie. Bilateral pneumpothorax was detected and chest tubes were placed. Emergent tracheotomy was performed due to hypoxia and difficult ventilation. Bronchoscopy revealed edema of the tracheal rings and main bronchi. Hemodynamic status and oxygenation improved and the patient was transformed to the intensive care unit. Upper airway ultrasound revealed a tongue thickness of 8.79cm (Figure 3). Inotrope infusions were gradually stopped and tracheostomy was removed on the third day. The patient was discharged on the seventh day. Conclusion: We believe that the simultaneous administration of two drugs with a low risk of allergic reactions could have contributed to the clinical situation via a cross reaction in this case. A detailed patient history and skin tests in the preoperative period and the measurement of serum IgE and tryptase levels in the postoperative period are very important in such patients. Anesthesiologists should be aware of the fact that life threatening drug reactions can happen in both intraoperative and postoperative periods in addition to the potential dangers of simultaneous multidrug administration. [ABSTRACT FROM AUTHOR] |
| قاعدة البيانات: |
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