A case of severe allergies in anaesthetic in children with congenital right cleft lip.

!---- child, male, 3 months old, 6kg, ASAIIwas admitted to hospital due to "congenital right cleft lip II degree" and was proposed to have a congenital cleft lip ii degree in the whole hemp downstream, and a nasal malformation correctionchildren have no history of allergies, hemoglobin 93g/L, the rest of the laboratory tests no abnormalitiesafter entering the chamberthe mask was sedated with 8% heptifluoroede, opened the lower extremities veins, intravenously injected 5% sodium glucose chloride, BP98/45mmHg, HR123 times/min, SpO2 99%, RR25 times/minthe intravenous pathway opens after closing the heptalflone volatile tank, anaesthetic induction: static injection atropine 02mg, dexamethasone 2mg, Medapyrin0000, propofol 10mg, Riffentani 20 mg, mask pressurized auxiliary breathing, 2min backline trachea intubationto listen to two lungs breathing sound and symmetricalventilator control breathing, VT8 ml/kg, RR28 times/min, airway pressure 16cm H2O, PETCO236mmHgpropofol 10mg kg-1 h-1 and riffentanil 0.3?g.kg-1-min-1 continuous intravenous infusion to maintain anesthesia30min after intubation, the child suddenly appears pale, lip purple, HR from 122 times / minute slowdown to 54 times / minute, BP from 90 / 41mmHg down to 52 / 31mmHg, SpO 288%, PETCO2 20mmHg and gradually declinecheck the trachea catheter and respiratory circuit no abnormalities, the body did not find the child's skin red rashimmediatehand breathing, decommissioning all narcotic drugs, speeding up infusions, and resining atropine 025mg, epinephrine 5 sg repeat static note 5 times, 10min after the child's lip gradually restored ruddy, BP78/46mmHg, HR141 times / minute, SpO2 100%, PETCO2 42mmHg, vital signs leveloffabout 60min after the child awake, self-breathing is good, the trachea catheter was removedat this time, the body found that the child's limb strain increased, tendon reflection, double-sided pupil is large, diameter of about 4mm, the light reflection is weakened, considering the presence of ischemic hypoxia encephalopathy, immediately static push to the semic2mg, pump inglycol 30ml, prevent cerebral edemaAfter 5min, children appear irritability, shortness of breath, head face, neck, torso skin red, two lungs and high-pitched snort sound and scattered sputum sound, children cry hoarse, body temperature 38.5 degrees C, BP97/47mmHg, HR205 times / minute, RR48 times / minute, SpO2 100% considerdrug allergies leading to anaphylactic shock, immediately give salbutamol 2 spray, myoinjection epinephrine 0.3mg, ice head cooling, mask oxygen, 10min post-blood gas analysis: pH7.27, standard alkali surplus (SBE)-12mmol /L, actual alkali residual (ABE)-11mmol/L, suggests acidpoisoning, sodium bicarbonate 10ml pumpinto acid, epinephrine 0.5mg plus physiological saline 2 ml atomization, 1h skin allergy symptoms reduced, BP, HR maintained in the normal range communicate with family members and surgeons, did not begin surgery and was transferred to the ICU to inquire about the medical history, the previous children due to "lower limb muscle tone increase" line rehabilitation treatment, the specific details are not known The child recovered and was discharged from hospital after 3d discussion Hu Yuxia and other research found that the allergic reactioncause of dexametison is mostly fast hair, 26.11% for the immediate administration, 30.57% for the administration of 5min, 26.11% for the administration of 30min, 20.38% for 0.5 to 2.0h, 7.01% after 2h the first time a child in this case developed anallergic symptoms 30min after anaesthetic induction due to the combination of drugs, and according to Zhu Shaojun and other reports, the most common drugs causing anaphylactic shock during the anaesthetic period were antibiotics (41.3%), followed by myamin (37%) and sedative hypnotic drugs (8.7%) the child did not use antibiotics and muscle pine drugs, the first suspected propofol, heptafluorone and medazole children with the first allergy did not consider dexamethasone as a suspicious allergy drug, which was then used to prevent cerebral edema, leading to the second allergic reaction The diagnosis of allergens during the anaesthetic period depends on skin tests and serological tests children developed two allergic reactions in a short period of time, and allergic symptoms occurred after the use of dexamethasone, according to clinical inference, the highly suspected anaphylactic shock caused by dexamethasone due to the anti-allergy effect of dexamethasone and the lack of understanding of the allergic reactions it produces, resulting in repeated clinical use of dexamethasone, multiple allergic reactions experience, greatly increased the patient's risk of medication, and even lead to death if dexamethasone is used in anti-allergy rescue process, can show the original allergic reaction symptoms aggravated or new allergy symptoms, should pay attention to the distinction , the first allergy in this case of children showed unexplained BP low, HR slow, SpO2 decline, the second allergy mainly manifested in red skin and lung shrank, clinical manifestations are diverse studies have shown that the mortality rate of allergic reactions during perioperative can reach 1.4%, and careful observation of early detection of allergy symptoms is the key to rescue once the diagnosis of allergic reactions, should promptly eliminate all suspects, stop all drugs used, actively expand capacity and timely and reasonable use of epinephrine epinephrine is a first-line drug used to treat severe allergic reactions, causing blood vessels to contract through excited ɑ receptors, BP recovering, reducing oozing, and rapidly reducing anaphylactic shock symptoms; the successful rescue of this child is due to the close observation of the condition in anesthesia and the timely and effective use of epinephrine .