Medline ® Abstracts for References 87,88
of 'Anaphylaxis: Emergency treatment'
Methylene blue for the treatment of refractory anaphylaxis without hypotension.
Bauer CS, Vadas P, Kelly KJ
Am J Emerg Med. 2013 Jan;31(1):264.e3-5. Epub 2012 May 23.
Anaphylaxis is a life-threatening reaction treated primarily with epinephrine. Methylene blue, a competitive inhibitor of guanylate cyclase, interferes with the vasodilatory actions of nitric oxide. It has recently been proposed by the Joint Taskforce on Practice Parameters as an alternative treatment for anaphylaxis with hypotension that is not responsive to classical therapy. Little evidence supports its use in normotensive patients with refractory anaphylaxis. We present the case of a 43-year-old woman with severe anaphylaxis unresponsive to epinephrine. Physical examination revealed marked respiratory distress, raised oral lesions, and altered mental status but lacked hypotension. After infusion of methylene blue, symptom resolution occurred almost immediately, and intubation was spared. Side effects were minimal. We propose methylene blue as a safe treatment option for refractory anaphylaxis, whether with or without hypotension.
Department of Pediatrics, Division of Allergy and Clinical Immunology, Children's Hospital of Wisconsin, Milwaukee, WI 53226, USA. firstname.lastname@example.org
[Successful extracorporeal resuscitation of a probable perioperative anaphylactic shock due to atracurium].
Lafforgue E, Sleth JC, Pluskwa F, Saizy C
Ann Fr Anesth Reanim. 2005 May;24(5):551-5. Epub 2005 Mar 17.
We report the case of a 55-year-old woman ASA 2 scheduled for a cholecystectomy, who presented 25 minutes after the induction, a circulatory arrest probably due to a cardiac anaphylaxis attributed to atracurium. After 60 minutes of futile resuscitation without any spontaneous cardiac rhythm a percutaneous cardiopulmonary bypass (CPB) was initiated. Twenty minutes later and after three external electric shocks electric cardiac activity returned normal. The weaning was possible 120 minutes later with catecholamine support. She left the intensive care unit on postoperative day seven after a laparotomy secondary to splenic injury due to intensive cardiopulmonary resuscitation. She was discharged home without any neurologic or cardiac sequellae. Biological assessment done during the circulatory arrest and cutaneous tests performed ten weeks later confirmed an isolated allergy to atracurium. CPB is the most efficient support in case of reversible cardiac arrest but unfortunately the less accessible outside from cardiac surgery unit.
Polyclinique Saint-Roch, 43 rue du Faubourg-Saint-Jaumes, 34967 Montpellier cedex 02, France.