Perioperative management of a patient with multiple drug hypersensitivity syndrome: Anesthesia perspective

Patients with multiple drug hypersensitivity often pose significant challenge during surgery because of the greater risk of developing anaphylactic shock that could be fatal. The use of novel pharmaceutical agents such as anesthetic drugs and medical devices made from a wide range of chemicals and materials with unknown antigenicity potentially predisposes this subset of patients to hypersensitivity reactions in the perioperative period. The authors encountered a 20-year-old patient with a history of multiple drug hypersensitivities, who had been diagnosed with a huge ovarian tumor. She underwent surgery successfully but faced a rather difficult recovery. Herein, we discuss the management of unexpected perioperative outcomes with the support of literature review. This article also highlights the use of drug provocation tests and the necessary precautions to be taken in the absence of standardized preoperative guidelines for patients with multiple drug hypersensitivity syndrome undergoing major surgical procedures. Key words: Multiple hypersensitivity; Perioperative; Anesthesia; Suture; Drug provocation test Citation: Sany S, Leow VM, Ghaffar ZA, Lim JA, Chong SE. Perioperative management of a patient with multiple drug hypersensitivity syndrome: Anesthesia perspective. Anaesth. pain intensive care 2020;24(6):__ Received: 10 August 202-, Reviewed: 29 October, 1 November 2020, Accepted: 1 November 2020

Dermatologic Emergencies in the Intensive Care Unit

Rashes are relatively common in hospitalized patients, but only rarely are they life threatening. Emergent skin conditions in these patients are usually sequelae of medication reactions (drug eruptions) or complications from sepsis. Most drug eruptions are benign and resolve if the offending medication is discontinued. However, the drug hypersensitivity syndrome, Stevens-Johnson syndrome (SJS), and toxic epidermal necrolysis (TEN) are urgent conditions that require prompt diagnosis and management. Purpura fulminans can develop in patients with sepsis and disseminated intravascular coagulation.