Znieczulenie podpajęczynówkowe do cięcia cesarskiego powikłane wstrząsem neurogennym i anafilaktycznym – opis przypadku

*Dariusz Węgrzyn¹, Andrzej Kolasa², Agnieszka Kutwin-Chojnacka², Wioletta Węgrzyn³, Wojciech Przybylski⁴

Summary
Background.Severe anaphylaxis is a systemic reaction affecting two or more organs or systems and is due to the release of active mediators from mast cells and basophiles. General anaesthesia may make the diagnosis of anaphylaxis more difficult, and awake techniques may contribute to faster recognition and treatment.
Case report. A 31-yr-old multipara received spinal anaesthesia with 15 mg bupivacaine, for a caesarean section. Three minutes after injection, her blood pressure rapidly decreased and could not be measured. 50 mg ephedrine was administered intravenously, resulting in rapid recovery. Following the delivery of a male infant, Apgar score 10, the mother received 1g of ceftriaxone. Immediately after injection, she became restless, developed urticaria, and began coughing. She then lost consciousness and went into a severe anaphylactic shock. 1 mg adrenaline followed by a continuous infusion of noradrenaline and hydrocortisone resulted in rapid recovery.
Discussion. Anaphylaxis is a serious complication of anaesthesia and surgery. Vasodilatation and hypovolaemic shock during spinal anaesthesia and sympathetic blockade may be especially difficult to treat. Special attention should be paid to high risk patients who are known to be allergic to penicillin.

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