[Anaphylactic cardiocirculatory failure after intraoperative application of dipyrone]

In our case, a 48-year-old healthy woman undergoing elective tympanoplasty under general anesthesia received an infusion of 2 g dipyrone in 100 ml 0.9% sodium chloride solution for pain prophylaxis. After receiving 1 g dipyrone within 5 min, the patient exhibited a cardiocirculatory failure and cyanosis and had to be resuscitated. After 20 min of cardiopulmonary resuscitation and administration of 3mg epinephrine and 2 mg norepinephrine, a stable circulation was reestablished. After exclusion of a fulminant pulmonary embolism and a primary cardiac event by computer tomography, electrocardiogram and enzyme diagnostics, the patient was transferred to an intensive care unit where she was mechanically ventilated for a period of 6 h. After 2 days of intensive monitoring, she was transferred to a peripheral ward,where she exhibited a normal neurological status and stable cardiocirculatory condition. A postoperatively performed allergy testing revealed a type I sensitization to dipyrone, which was responsible for the intraoperative cardiocirculatory failure due to a massive anaphylactic reaction. However, in this case, the typical symptoms of allergic reactions such as erythema, edema or bronchospasm were missing, which did not allow for an immediate diagnosis. CONCLUSION. Regarding the frequent perioperative use of dipyrone and the severity of anaphylaxis observed in this case, it should be considered that this analgesic should be applied intravenously only if adequate safety measures such as emergency therapy option and patient monitoring are guaranteed as recommended by the German drug regulation authority since 1982.