Suspected anaphylaxis from intravenous cefazolin during general anaesthesia in a dog
- Published
- Accepted
- Subject Areas
- Allergy and Clinical Immunology, Anesthesiology and Pain Management, Emergency and Critical Care, Pharmacology, Veterinary Medicine
- Keywords
- drug reaction, antibiotic, resuscitation, anaphylactic, hypersensitivity
- Copyright
- © 2016 Prebble et al.
- Licence
- This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, reproduction and adaptation in any medium and for any purpose provided that it is properly attributed. For attribution, the original author(s), title, publication source (PeerJ Preprints) and either DOI or URL of the article must be cited.
- Cite this article
- 2016. Suspected anaphylaxis from intravenous cefazolin during general anaesthesia in a dog. PeerJ Preprints 4:e2275v1 https://doi.org/10.7287/peerj.preprints.2275v1
Abstract
A 6-year-old female Shetland Sheepdog with a history of cardiorespiratory compromise during general anaesthesia was referred for ovariohysterectomy surgery. Clinical examination was unremarkable at presentation and physiologic parameters under general anaesthesia were within expected ranges during preparation for surgery. Shortly after completion of an intravenous injection of cefazolin, the audible signal from the Doppler ultrasound unit stopped. A rapid survey of the patient revealed tachycardia with weak femoral pulses, tachypnoea, hyperpnoea and substantially increased resistance to manual positive pressure ventilation. Stopping inhalant anaesthesia, administering salbutamol, corticosteroids and diphenhydramine were associated with resolution of clinical signs. However, marked hypotension and resistance to ventilation recurred approximately 25 minutes later. Low dose intravenous epinephrine (5 mcg/kg) was effective at increasing arterial blood pressure and reversing respiratory dysfunction. Surgery was completed and the patient recovered uneventfully. Initial reliance on second line therapy and delay in administering epinephrine, the recommended treatment for anaphylaxis, may have slowed resolution of clinical signs.
Author Comment
This preprint describes a case of anaphylaxis during general anaesthesia in a dog, suspected to have resulted from a reaction to the antibiotic cefazolin. Anaphylaxis is a very uncommon peri-anaesthetic complication, estimated to occur in 1 in 10,000 to 20,000 human anaesthetics, but has a high mortality rate of between 4-10%. Few cases have been reported in the veterinary literature, where there is substantial variation in the consistency of case management and outcome. We hope that this case highlights the benefits of appropriate first line therapy (epinephrine) versus second line therapy (corticosteroids, antihistamines, bronchodilators). This case has been submitted to BMJ Veterinary Record Case Reports.