Faculty Collaboration Database

Anaphylaxis secondary to albumin infusion during posterior spinal fusion for pediatric scoliosis. Spine Deform 2020 Apr;8(2):327-331

Date

02/08/2020

Pubmed ID

32030641

DOI

10.1007/s43390-020-00027-2

Scopus ID

2-s2.0-85079773035 (requires institutional sign-in at Scopus site)   3 Citations

Abstract

STUDY DESIGN: Case report.

OBJECTIVES: To describe intraoperative administration of albumin as a cause of immunoglobulin E (IgE)-mediated anaphylaxis and cardiac arrest in an adolescent with adolescent idiopathic scoliosis.

BACKGROUND: Albumin is considered the reference intraoperative colloidal solution, and is used commonly as a volume expander for treating hypovolemia. Albumin rarely causes an anaphylactic reaction, with a documented rate of only 0.099%.

METHOD: An adolescent with scoliosis experienced acute, intraoperative hypotension during exposure for planned T5-L4 posterior spinal fusion shortly after infusion of albumin. She was treated rapidly and successfully with CPR and epinephrine.

RESULTS: Intraoperative transesophageal echocardiogram, chest radiograph, and serum histamine, serum tryptase, and urine N-methyl-histamine laboratory tests confirmed albumin anaphylaxis to be the etiology of the intraoperative event. Further postoperative complications were avoided as a result of the rapid diagnosis and treatment.

CONCLUSIONS: Although rare, IgE-mediated anaphylaxis to albumin, if administered, must be considered a possible cause of acute, intraoperative hypotension. Rapid management of anaphylaxis with communication between the surgeon, anesthesia team, and operative staff are essential if additional complications are to be avoided.

Author List

Daniel B, Wanner JP, Emerson B, Martus JE

Author

John P. Wanner MD Assistant Professor in the Orthopaedic Surgery department at Medical College of Wisconsin

MESH terms used to index this publication - Major topics in bold

Acute Disease
Adolescent
Albumins
Anaphylaxis
Cardiopulmonary Resuscitation
Early Diagnosis
Epinephrine
Female
Humans
Hypotension
Immunoglobulin E
Intraoperative Care
Intraoperative Complications
Intraoperative Period
Scoliosis
Spinal Fusion
Treatment Outcome