[Anaphylactic shock after tourniquet removal in orthopedic surgery]

Case report of six patients who experienced symptoms of severe anaphylactic shock, after tourniquet release at the end of minor orthopaedic surgery of the limbs under regional anaesthesia. The immunological mechanism of the shock was confirmed by prick tests. The causative agent was rifamycin SV used for cleaning the surgical wound prior to its closure. In case of repetitive surgery and/or in allergic patients the use of another antibiotic or the simple cleaning of the wound with normal saline should be considered. In case of surgery using a tourniquet, an iv access should be maintained for 1 hour after tourniquet release and the patient closely monitored in the recovery room. The allergologic assessment should take place 3 to 6 weeks later and include all drugs administered during the 10 minutes preceding the occurrence of shock.