Anaphylactic Shock After Indocyanine Green Video Angiography During Cerebrovascular Surgery

• Published in: World neurosurgery Vol. 133; pp. 74 - 79
• Main Authors: Kim, Moinay, Lee, Seungjoo, Park, Jung Cheol, Jang, Dong-Min, Ha, Seung Il, Kim, Joung-Uk, Ahn, Jae Sung, Park, Wonhyoung
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.01.2020
• Subjects: Aged; Anaphylactic shock; Anaphylaxis; Anaphylaxis - etiology; Angiography, Digital Subtraction - adverse effects; Cerebral aneurysm; Cerebral Angiography - adverse effects; Female; Humans; Indocyanine green; Indocyanine Green - adverse effects; Intracranial Aneurysm - surgery; Middle Aged; Neurosurgical Procedures - adverse effects; Surgery; Cerebral aneurysm; Anaphylaxis; Anaphylactic shock; Surgery; IA; Indocyanine green; EP; VA; ICG
• ISSN: 1878-8750; 1878-8769
• DOI: 10.1016/j.wneu.2019.09.135

Indocyanine green (ICG) video angiography has been widely used in cerebrovascular surgery. ICG injection is generally safe, with a low incidence of complications. ICG-related anaphylactic reactions during neurosurgery have been rarely reported. We report the cases of 2 patients who had experienced anaphylactic shock in response to intravenous ICG injection (DID Indocyanine Green [Dongindang, Inc., Gyeonggi-do, Republic of Korea]) during intracranial aneurysm (IA) surgery. The first patient, a 69-year-old woman with an unruptured IA, had been undergoing clipping surgery under general anesthesia. Immediately after ICG injection, her blood pressure suddenly decreased from 140/80 mm Hg to 50/30 mm Hg and she developed a skin rash on her abdomen and all extremities. Chest compression was initiated, and her vital signs gradually recovered to their pre-ICG levels within 10 minutes. The second patient was a 58-year-old woman with an unruptured IA who had been undergoing clipping surgery. After ICG injection, her blood pressure had decreased from 130/80 mm Hg to 60/40 mm Hg, and a rash-like skin lesion was observed on her abdomen. After intravenous injection of norepinephrine and dexamethasone, her blood pressure recovered to its pre-ICG level within 30 minutes and remained stable thereafter. The postoperative ICG skin provocation test findings were positive for both patients; however, only 1 patient showed markedly increased serum tryptase levels. Despite the rarity of ICG-related anaphylaxis, clinicians should be aware of this unexpected, but potentially life-threatening, drug reaction in patients undergoing cerebrovascular surgery.