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.

Indication for and technical refinements of submental intubation in oral and maxillofacial surgery.

INTRODUCTION: In maxillofacial injuries, a choice has often to be made between different ways of intubation when surgical access to both the nasal and the oral cavities is necessary. Submental intubation is an interesting alternative to tracheotomy, especially when short-term postoperative control of the airway is foreseeable, and as control of the dental occlusion is complete, and access to the nose and mouth is undisturbed. MATERIAL: This kind of intubation has been used in our department in 25 cases since 1997. All patients had fractures disturbing the dental occlusion plus either an associated fracture of the skull base, or a displaced nasal fracture. RESULTS: There was no intra-operative complication, average intubation duration was 1.5 days. Post-operative complications consisted of one case with hypertrophic scarring and two cases of abscess formation in the floor of the mouth. All these completely healed following local conservative treatment. CONCLUSION: Submental intubation demands certain technical skills but it is simple, rapid and may avoid tracheotomy in selected patients.