ANAPHYLACTIC SHOCK DURING USE OF HIGH-DOS E APROTININ IN CARDIAC-SURGERY

A 77-year-old man was admitted for mitral valve replacement, 46 days a fter a failed conservative mitral surgery where he received high-dose aprotinin. Twenty minutes after induction of anaesthesia, 250 UPh E of aprotinin were infused intravenously; before the end of this infusion , bronchospasm, systemic hypotension and generalized rash were noted. Immediate treatment included intravenous adrenaline and methylpredniso lone; cardiovascular stability was restored after 10 minutes. Immediat e histamine liberation was confirmed by the analysis of the time cours e of the clinical events, a previous contact and positive skin tests. Aprotinin has the antigenic molecular structure of natural proteins. S ince 1987, it is used in cardiac surgery to reduce postoperative blood loss: to prevent serious allergic reactions to aprotinin, it is neces sary, in patients known to have had previous aprotinin therapy, to per form skin testing with diluted aprotinin before infusion.