Anaphylaxis to dyes during the perioperative period: reports of 14 clinical cases.

BACKGROUND: Vital dyes are widely used for lymphatic mapping and sentinel lymph node biopsy in patients with malignant tumors, and reports of anaphylactic reactions are becoming more frequent. OBJECTIVE: Our aims were to describe specific clinical features of hypersensitivity reactions to Patent Blue (Guerbet, Roissy, France), results of the allergy workup, and their consequences for patient management. METHODS: We report a series of 14 clinical cases of dye-induced anaphylaxis recorded between 2004 and 2006 in 4 member centers of a network of French allergoanesthesia outpatient clinics. RESULTS: Reactions appeared to be relatively severe (6/14 grade III reactions). An average 30 +/- 6-minute delay was observed between dye injection and symptom onset. In 9 (65%) patients reactions were sustained for several hours, requiring prolonged continuous epinephrine infusion and transfer to an intensive care unit. Prick test results were positive in 8 patients. In 5 patients prick test results were negative, whereas intradermal test results were positive. CONCLUSION: Anesthesiologists and allergologists must be aware of this specific risk and of the clinical characteristics of these reactions, which are usually delayed and long lasting.

Intranasal lidocaine plus naphazoline nitrate improves surgical conditions and perioperative analgesia in septorhinoplasty surgery.

BACKGROUND: Septorhinoplasty is a traumatic procedure that is associated with epistaxis and postoperative pain. The primary objective of this randomized double-blind controlled trial was to determine whether intranasal 5% lidocaine plus naphazoline decreases postoperative pain and lessens the use of rescue analgesics. METHODS: After induction of general anesthesia and laryngeal topical anesthesia with 5% lidocaine, 28 adult patients, scheduled to undergo septorhinoplasty, were randomly assigned to one of two groups, either topical intranasal saline 20 ml (control group) or intranasal 5% lidocaine plus naphazoline solution 0.2 mg ml(-1) (lidocaine group). The perioperative dose of sufentanil, the mean end-tidal concentration of isoflurane, and surgeon satisfaction with the operative field were recorded. In the lidocaine group, plasma lidocaine concentrations were sampled 15, 20, 25, 35, 45, and 55 min after induction of anesthesia. Visual analogue scale pain scores were recorded 30, 60, 90, and 120 min after the patients arrived in the postanesthesia care unit and 24 h after surgery. Consumption of morphine rescue analgesia and the occurrence of any side effects were recorded at the end of the 24-h study period. RESULTS: The intranasal lidocaine-naphazoline application decreased isoflurane requirements [median values: 0.8% (0.7-1.5) vs. 1.2% (0.9-1.8), respectively; P = 0.04] and enhanced surgical conditions. Patients in the lidocaine group experienced less postoperative pain than the control group [1 h after surgery: median values of visual analogue scale: 0 (0-20) vs. 50 (30-80), respectively; P = 0.001], and they required fewer doses of subcutaneous morphine. Total plasma concentrations of lidocaine remained below 4 microg ml(-1) throughout the study period. CONCLUSIONS: Intranasal lidocaine plus naphazoline is a simple and efficient technique for decreasing intra- and postoperative pain and for lessening rescue analgesic requirements in the postoperative period after septorhinoplasty. Toxic plasma concentrations of lidocaine were not reached.