[Bronchospasm due to anaphylactic reaction to Hydroxyethyl starch (HESPANDER)]

A 14-year-old male without any history of allergic disorders developed severe bronchospasm with skin rash 15 min. after the administration of hydroxyethyl starch (HES) during thoratic epidural anesthesia supplemented with N2O-sevoflurane-O2 anesthesia. Aminophylline, hydrocortisone, and epinephrine were administered. These treatments were effective, and the airway pressure was restored to normal ranges within 3 hrs. After the operation, the patient was extubated, because the results of the arterial blood gas examinations recovered to normal ranges. Plasma histamine and complement levels were almost within normal limits, but IgE levels were approximately 5 times higher than normal. Subsequent immediate skin test with hydroxyethyl starch showed an immunologically positive response. These results demonstrate evidence that an anaphylactic reactions could occur just after the start of HES infusion. Severe adverse reactions to HES are very rare, but it is important to keep the possibility always in mind.