Intraoperative anaphylactic shock related to fibrin glue application during video-assisted thoracoscopic surgery

胸腔鏡手術中にフィブリン糊によるアナフィラキシーショックを来たした1例

Intraoperative anaphylactic shock related to fibrin glue application during video-assisted thoracoscopic surgery

Creators Yano Yuka

Creators Kuga Takayuki

Creators Sakamoto Ryuunosuke

Creators Shigeta Masatoshi

Creators Iida Yasuhiko

フィブリン糊は出血箇所の閉鎖や臓器創傷部の接着など外科手術で広く用いられている.胸腔鏡手術中にフィブリン糊によるアナフィラキシーショックを来たした症例を経験したので報告する.症例は83歳女性．右肺癌(cStageⅠA1)疑いで診断,治療目的に胸腔鏡下肺部分切除術が施行された.肺の切離断端からエアリークを認めたため,ボルヒール®を塗布したところ数分以内に急激な血圧低下,全身性紅班がありフィブリン糊によるアナフィラキシーショックが疑われた.カテコラミン投与と輸液負荷にてショック状態を離脱することができた.また原因と考えられるフィブリン糊の除去と胸腔内洗浄も有効であった.フィブリン糊など生物学的製剤を使用する際は副作用としてアナフィラキシーショックに注意する必要がある.

Fibrin glue is used across most surgical specialties. We report a case of anaphylactic shock attributable to intraoperative fibrin glue application. An 83-year-old woman with suspected primary lung cancer(clinical stage IA)underwent video-assisted partial resection of the right upper lobe. She developed air leakage after the procedure, and fibrin glue was applied to seal the site of leakage. The patient showed a sudden reduction in blood pressure and developed skin rash within a few minutes, which were attributable to fibrin glue-induced anaphylactic shock. She was immediately treated with rapid infusion and catecholamine administration. We removed as much of the fibrin glue as possible, resulting in improvement in her general condition. Clinicians should be aware that intraoperative use of biological tissues can precipitate anaphylactic shock.

[ISSN]0513-1731

[NCID]AN00243156