Anaphylaxis to pantoprazole during general anesthesia.

Area of Science:

• Anesthesiology
• Pharmacology
• Immunology

Background:

• Anaphylaxis during general anesthesia is commonly linked to neuromuscular blocking agents, antibiotics, and latex.
• Proton pump inhibitors (PPIs) are frequently administered perioperatively for stress ulcer prophylaxis.
• Perioperative anaphylaxis attributed to PPIs is infrequently documented.

Observation:

• A 50-year-old male patient developed anaphylaxis during general anesthesia.
• The reaction manifested as hypoxemia, hypotension, tachycardia, and generalized erythema.
• This occurred shortly after intravenous administration of pantoprazole (40 mg) and methylprednisolone (1 g).

Findings:

• The patient was successfully resuscitated and experienced no lasting adverse effects.
• A skin test performed six months post-surgery yielded a positive result for pantoprazole.
• This suggests pantoprazole was the causative agent for the anaphylactic episode.

Implications:

• This case highlights the potential for perioperative anaphylaxis to PPIs, specifically pantoprazole.
• It underscores the importance of considering less common agents in the differential diagnosis of intraoperative anaphylaxis.
• Further investigation into PPI-induced anaphylaxis may be warranted to improve patient safety during surgery.