Successful treatment of severe adrenaline-resistant anaphylactic shock with glucagon in a patient taking a beta-blocker: a case report

Background The efficacy of glucagon for adrenaline-resistant anaphylactic shock in patients taking β-blockers is controversial. However, understanding the efficacy of glucagon is important because adrenaline-resistant anaphylactic shock is fatal. We present a case of severe adrenaline-resistant anap...

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Published inJA clinical reports Vol. 7; no. 1; p. 86
Main Authors Murakami, Yu, Kaneko, Shohei, Yokoyama, Haruka, Ishizaki, Hironori, Sekino, Motohiro, Murata, Hiroaki, Hara, Tetsuya
Format Journal Article
LanguageEnglish
Published Berlin/Heidelberg Springer Berlin Heidelberg 15.12.2021
Springer Nature B.V
SpringerOpen
Subjects
Adrenaline
Anaphylaxis
Anesthesiology
Case Report
Case reports
Critical Care Medicine
Emergency Medicine
Glucagon
Hemodynamics
Hypotension
Intensive
Medicine
Medicine & Public Health
Pain Medicine
Therapeutic management
β-blockers
β-blockers
Anaphylaxis
Therapeutic management
Glucagon
Adrenaline
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Summary:Background The efficacy of glucagon for adrenaline-resistant anaphylactic shock in patients taking β-blockers is controversial. However, understanding the efficacy of glucagon is important because adrenaline-resistant anaphylactic shock is fatal. We present a case of severe adrenaline-resistant anaphylactic shock in a patient taking a β-blocker, and glucagon was effective in improving hemodynamics. Case presentation An 88-year-old woman with severe aortic stenosis and taking a selective β-1 blocker underwent transcatheter aortic valve implantation under general anesthesia. Postoperatively, she received 100 mg sugammadex, but 2 min later developed severe hypotension and bronchospasm. Suspecting anaphylactic shock, we intervened by administering adrenaline, fluid loading, and an increased noradrenaline dose. Consequently, the bronchospasm improved, but her blood pressure only increased minimally. Therefore, we administered 1 mg glucagon intravenously, and the hypotension resolved immediately. Conclusions Glucagon may improve hemodynamics in adrenaline-resistant anaphylactic shock patients taking β-blockers; however, its efficacy must be further evaluated in more cases.
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ISSN:2363-9024
2363-9024
DOI:10.1186/s40981-021-00490-4