[Two cases of asthmatic attack caused by spinal anesthesia]

Case 1: A 26-year-old primipara, underwent emergency cesarean section because of premature rupture of membrane and breech presentation in her 36th week of gestation. She had no history of asthma, but physical examination revealed atopic dermatitis in the neck and the arms. Case 2: A 21-year-old woman underwent removal of ovarian cyst. She had a history of asthma in her childhood. On physical examination there was no abnormal findings. For both cases spinal anesthesia was uneventfully induced using 2 and 3 ml of 0.4% tetracaine in 10% dextrose respectively. Sensory loss to cold extended to T3 in both cases. Immediately after the anesthesia reached two level, the first patient began to cough and the second patient complained of difficulty in breathing, and then both became dyspneic in 10-15 minutes thereafter. Wheezing rhonchi was audible in both cases. Both patients recovered fully with antiasthmatic therapy. There was no shock, nor change of the skin and the mucosa. The baby also had no problem postoperatively. Skin reaction to intradermal injection of 0.025 ml of 0.4-0.00004% tetracaine in normal saline was tested on two patients and on eleven volunteers. At higher concentrations it resulted in positive in the patients and all the volunteers, and at lower concentrations it resulted in positive in case 2 and under-positive in case 1 and three volunteers having histories of allergic disease. Skin testing alone does not offer any diagnostic of tetracaine allergy, because tetracaine might be a chemical irritant. Thoracic adrenergic nerve blockade due to spinal anesthesia might trigger asthmatic attack by influencing the cholinergic ganglia of the lung and/or pulmonary blood flow.