Kinin-mediated anaphylactoid reaction implicated in acute intra-operative pulseless electrical activity

Area of Science:

• Anesthesiology
• Pharmacology
• Immunology

Background:

• Total hip replacement surgery necessitates careful anesthetic management.
• Plasma expanders like polygeline (Haemaccel) are used to manage intraoperative fluid shifts.
• Anaphylactoid reactions can occur during anesthesia, posing diagnostic challenges.

Observation:

• A 65-year-old patient developed pulseless electrical activity during general anesthesia for hip replacement.
• The patient experienced a fatal outcome following administration of polygeline plasma expander (Haemaccel).
• In vitro testing suggested a kinin-mediated anaphylactoid reaction.

Findings:

• The adverse event was attributed to a non-histaminoid, kinin-mediated anaphylactoid reaction.
• This specific type of reaction demonstrated resistance to standard epinephrine treatment.
• Diagnostic challenges arise from the atypical presentation of non-histaminoid anaphylactoid reactions.

Implications:

• Highlights the potential for severe, fatal reactions to plasma expanders.
• Underscores the importance of recognizing and differentiating non-histaminoid anaphylactoid reactions.
• Suggests a need for alternative or adjunctive treatments for kinin-mediated hypotension unresponsive to epinephrine.