Intraoperative Anaphylactic Reaction: Is it the Floseal?

Area of Science:

• Anesthesiology
• Immunology
• Surgical Innovation

Background:

• Intraoperative hemodynamic or respiratory instability requires prompt identification of the inciting event for patient safety.
• Anaphylactic reactions, though uncommon, are a potential cause of intraoperative cardiorespiratory instability.
• Common triggers during anesthesia include neuromuscular blocking agents, antibiotics, and latex.

Observation:

• Floseal, a topical hemostatic agent derived from human thrombin, animal collagen, and gelatin, is frequently used in orthopedic surgery.
• Two pediatric patients undergoing posterior spinal fusion experienced intraoperative hemodynamic and respiratory instability after Floseal administration.
• These events suggest a potential for allergic reactions to components within Floseal.

Findings:

• The cases highlight Floseal as a potential, albeit uncommon, cause of intraoperative anaphylaxis in pediatric surgical patients.
• Review of previous reports indicates a pattern of hypersensitivity reactions to topical hemostatic agents.
• The study underscores the importance of considering Floseal in the differential diagnosis of unexplained intraoperative instability.

Implications:

• Perioperative care protocols should include vigilance for anaphylaxis related to hemostatic agents like Floseal.
• Awareness among anesthesiologists and surgeons regarding this potential adverse event is critical.
• Further research into the immunogenic properties of topical hemostatic agents may be warranted to improve patient safety.