100110 - Perioperatives reaction to morphine

Perioperatives reactions are an increasing cause of consultation in an allergist dayto day practice. In some cases it is difficult to assess the causal agent of thesereactions, due to lack of proper registry of the administration of the differentmedications needed for the anesthetic induction. Among the drugs that areusually used in the anesthetic induction Neuromuscular blocking agents (NMBAs)are a frequent cause of perioperative reactions (1)We present the case of a 59 years old woman who suffered in the operation room,prior to a knee surgery, sudden rash and pruritus (which started in the palms ofher hands and soles of the feet) right after the administration of propofol andmorphine.The anesthetist administered antihistamines and corticosteroids intravenously. Thesurgery, once the symptomatology had been reverted, could be performed withoutany further issues.As far as the patient was concerned, this was the first time she had undertookpropofol and morphine. She was not sure if she had ever used any other opioids.Skin testings including prick tests and intradermal reaction (IDR) were performed,these being:PRICK Morphine 1mg/ml POSITIVE (8mmx 8.5 mm) IDR MORPHINE 0.1mg/mlPOSITIVE (Growth of >7mm)Prick PROPOFOL (10mg/ml) negative, IDR PROPOFOL (0.1mg/ml, 1mg/ml) negativeRegarding the result, we proceeded to perform skin testing with fentanyl, to givethe patient further safe alternatives to morphine.Prick FENTANYL 0.05 mg/ml negative, IDR fentanyl 0.005 mg/ml negative.We prohibited further use of morphine as treatment for the patient, giving thealternative of fentanyl to use whenever it was considered necessary always underphysician's supervision and prescription.After we ended our study, the patient underwent another meniscal intervention inwhich fentanyl was used in the anesthetic induction. The patient did notexperience any reaction.When a perioperative reaction happens, it is critical to take into account multipledrugs that may be involved in it. A proper register of the medicines that wereadministered and the timing of the administration is key to facilitate de Allergistwork.