Refractory anaphylactic cardiac arrest after succinylcholine administration

Area of Science:

• Anesthesiology
• Immunology
• Critical Care Medicine

Background:

• Refractory shock and cardiac arrest are critical complications that can arise during the induction of general anesthesia.
• Anaphylaxis, a severe allergic reaction, is a potential cause of such refractory shock.
• Identifying the cause of cardiac arrest during anesthesia induction is crucial for patient management.

Observation:

• Two cases of fatal cardiac arrest occurred shortly after the administration of succinylcholine during general anesthesia induction.
• Post-mortem blood analysis revealed elevated levels of tryptase and immunoglobulin E (IgE) in both patients.
• These findings suggest a severe anaphylactic reaction as the cause of death.

Findings:

• Elevated serum tryptase and immunoglobulin E (IgE) levels are indicative of anaphylaxis.
• Succinylcholine administration was temporally associated with the fatal anaphylactic reactions and cardiac arrest.
• Tryptase and IgE assays can be valuable diagnostic tools in cases of unexplained cardiac arrest during anesthesia induction.

Implications:

• The findings highlight the potential for severe anaphylaxis to succinylcholine, even in the absence of prior sensitization history.
• Measuring serum tryptase and IgE levels should be considered in the workup of patients experiencing cardiac arrest during anesthesia induction.
• This may improve the diagnosis of anaphylaxis and inform future anesthetic practices to prevent similar fatal outcomes.