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Canadian Journal of Anesthesia 47:478 (2000)
© Canadian Anesthesiologists' Society, 2000

Correspondence

Transesophageal echocardiography in the management of anaphylactic shock

W. Anton Visser, Frederik W. Santman, Helmut R. Gehlmann and Wim R.M. Aengevaeren

Nijmegen, The Netherlands

To the Editor:

We would like to present the use of transesophageal echocardiography (TEE) in the management of anaphylactic shock.

After infusion of dextran, a 47-yr-old man suffered an anaphylactic reaction, consisting of hypotension and bronchospasm. Prednisolone and aminophylline were given and, after midazolam and rocuronium, the trachea was intubated. Large amounts of pink frothy fluid appeared in the endotracheal tube. In the ICU, mechanical ventilation was started with PEEP of 16 cm H2O. A pulmonary artery catheter was inserted and a CVP of 20 mmHg and pulmonary capillary wedge pressure (PCWP) of 26 mmHg were measured. Chest X-ray showed massive pulmonary edema. Continuous infusion of epinephrine was started to maintain blood pressure (BP), but without success.

A TEE examination showed good myocardial contractility and no cardiac tamponade. Ventricular dimensions were small. However, CVP and PCWP were elevated, indicating a small circulating blood volume in a contracted vascular system, caused by massive extravascular fluid trapping in the lungs and vasopressor-induced vasoconstriction. Under TEE monitoring, 1500 ml of a gelatin colloid were infused until the ventricular dimensions appeared normal. The BP and SaO2 improved to normal, while PAP and PCWP remained unchanged. Epinephrine was discontinued and hemodynamic variables remained stable.

Although infusion of fluids is generally necessary to treat hypotension during anaphylactic shock, we felt this may be hazardous in the presence of high PCWP and pulmonary edema. TEE was helpful in evaluating the intravascular volume status, and complemented pressure measurements of the PA catheter.





This Article
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Right arrow Articles by Aengevaeren, W. R.M.

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