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[Morphine-induced Anaphylaxis before Induction of Anesthesia]
Masui. the Japanese Journal of Anesthesiology
|May 19, 2016
Summary
A 67-year-old man experienced severe anaphylaxis, likely due to morphine administration before mitral valve surgery. Prompt resuscitation successfully revived him, highlighting the critical need for vigilance in opioid-induced allergic reactions.
Area of Science:
- Anesthesiology
- Cardiology
- Clinical Immunology
Background:
- A 67-year-old male patient was scheduled for mitral valve prolapse (MVP) surgery due to mitral regurgitation (MR).
- Pre-operative administration of morphine 5 mg intramuscularly preceded the event.
Observation:
- The patient developed symptoms of anaphylaxis, including itching and nettle rash, shortly after morphine injection.
- Rapid deterioration of vital signs occurred, with severe hypotension (40/20 mmHg) and tachycardia (120 bpm), progressing to pulseless electric activity (PEA).
Findings:
- Intravenous fluids, methylprednisolone, ulinastatin, and ranitidine were administered, followed by adrenaline and cardiopulmonary resuscitation (CPR) for PEA.
- The patient was successfully resuscitated and stabilized with vasopressors (dopamine, dobutamine, noradrenaline) and transferred to the high care unit (HCU).
Implications:
- This case underscores morphine as a probable trigger for severe anaphylaxis in a surgical patient.
- Immediate recognition and aggressive management are crucial for favorable outcomes in opioid-induced anaphylactic emergencies.
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