Kounis syndrome caused by multidrug combination before anesthesia induction
10.3760/cma.j.cn114015-20240108-00013
- VernacularTitle:麻醉诱导前多药联用致Kounis综合征
- Author:
Jianghua SHEN
1
;
Miao LIU
;
Chen LIU
;
Qian LIU
;
Yanqi CHU
;
Xuexin FENG
Author Information
1. 首都医科大学宣武医院药学部，北京 100053
- Publication Type:Journal Article
- Keywords:
Glucocorticoids;
Midazolam;
Ondansetron;
Kounis syndrome;
Anesthesia induction
- From:
Adverse Drug Reactions Journal
2024;26(10):627-630
- CountryChina
- Language:Chinese
-
Abstract:
A 50-year-old male patient was scheduled to undergo epiglottic mass resection under general anesthesia due to an epiglottic cyst. Before anesthesia induction, the patient received dexamethasone, methylprednisolone, midazolam, and ondansetron by intravenous injectionin sequence. After 2 minutes, the patient complained of palpitations, abdominal spasmodic pain, cyanosis of the lips, and patchy changes in the skin on the chest and body. The electrocardiogram monitor showed a heart rate of 175 beats per minute, but his cuff blood pressure cannot be measured. His blood oxygen saturation was 0.76, and he did not respond to the call afterwards. Oxygen through a face mask and pressure ventilation, intravenous injection of 20 mg of esmolol twice were given immediately. The patient′s consciousness recovered, the heart rate gradually decreased to 60 beats per minute (sinus rhythm), and the blood pressure increased to 74/50 mmHg. Continuous IV pumping of norepinephrine 8 μg/min was given. After 25 minutes, the patient′s bedside electrocardiogram showed atrial fibrillation with ventricular differential conduction, myocardial injury or acute myocardial infarction, and QT interval prolongation. Then intravenous injection of furosemide 40 mg was given, his above symptoms were improved,his blood pressure recovered to 110-120/70 mmHg, blood oxygen saturation was 1.00, the skin spots on his chest and body disappeared, and his abdominal pain was alleviated. Anesthesiologists and pharmacists evaluated the patient′s adverse reactions and considered that there was a high possibility of type I Kounis syndrome caused by the combination of glucocorticoids, midazolam, and ondansetron.
