Type I anaphylactic reaction due to contrast induced angioedema causing neck swelling: the role of sitting fiberoptic bronchoscopy in emergent intubation
Journal of Cellular & Molecular Anesthesia,
Vol. 1 No. 3 (2016),
1 July 2016
Contrast induced angioedema is a rapidly progressive state involving a number of organ systems including the upper airway tract; which is usually a type I anaphylactic reaction also known as immediate hypersensitivity reaction. Prompt preservation of the respiratory tract is the cornerstone of this situation. The use of fiberoptic bronchoscope for tracheal intubation though very helpful, has some special considerations due to the anatomic distortions created by edema.
This manuscript describes a patient with contrast induced angioedema managed successfully. Serum levels of IgE were highly increased during the first hours after the event; while serum levels of complement were normal. However, rapid airway management and prophylactic intubation saved the patient and prevented the possible aftermath of airway obstruction.
Keywords: airway management; type I anaphylactic reaction, angioedema; fiberoptic bronchoscope.
Conflict of interest: none of the authors has any conflict of interest.
- airway management
- type I anaphylactic reaction
- fiberoptic bronchoscope
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Dabbagh A, Mobasseri N, Elyasi H, Gharaei B, Fathololumi M, Ghasemi M, et al. A rapidly enlarging neck mass: the role of the sitting position in fiberoptic bronchoscopy for difficult intubation. Anesth Analg. 2008;107(5):1627-9.
Dabbagh A, Rad MP, Daneshmand A. The relationship between night time snoring and cormack and lehane grading. Acta Anaesthesiol Taiwan. 2010;48(4):172-3.
Eberhart LH, Arndt C, Cierpka T, Schwanekamp J, Wulf H, Putzke C. The reliability and validity of the upper lip bite test compared with the Mallampati classification to predict difficult laryngoscopy: an external prospective evaluation. Anesth Analg. 2005;101(1):284-9.
Khan ZH, Kashfi A, Ebrahimkhani E. A comparison of the upper lip bite test (a simple new technique) with modified Mallampati classification in predicting difficulty in endotracheal intubation: a prospective blinded study. Anesth Analg. 2003;96(2):595-9, table of contents.
Sharma D, Prabhakar H, Bithal PK, Ali Z, Singh GP, Rath GP, et al. Predicting difficult laryngoscopy in acromegaly: a comparison of upper lip bite test with modified Mallampati classification. J Neurosurg Anesthesiol. 2010;22(2):138-43.
Pearce A. Evaluation of the airway and preparation for difficulty. Best Pract Res Clin Anaesthesiol. 2005;19(4):559-79.
Langeron O, Amour J, Vivien B, Aubrun F. Clinical review: management of difficult airways. Crit Care. 2006;10(6):243.
El-Orbany M, Woehlck HJ. Difficult mask ventilation. Anesth Analg. 2009;109(6):1870-80.
Hernandez MR, Klock PA, Jr., Ovassapian A. Evolution of the extraglottic airway: a review of its history, applications, and practical tips for success. Anesth Analg. 2012;114(2):349-68.
Mhyre JM, Healy D. The unanticipated difficult intubation in obstetrics. Anesth Analg. 2011;112(3):648-52.
Lee A, Fan LT, Gin T, Karmakar MK, Ngan Kee WD. A systematic review (meta-analysis) of the accuracy of the Mallampati tests to predict the difficult airway. Anesth Analg. 2006;102(6):1867-78.
Practice guidelines for management of the difficult airway: an updated report by the American Society of Anesthesiologists Task Force on Management of the Difficult Airway. Anesthesiology. 2003;98(5):1269-77.
Frova G, Sorbello M. Algorithms for difficult airway management: a review. Minerva Anestesiol. 2009;75(4):201-9.
Rich JM. Recognition and management of the difficult airway with special emphasis on the intubating LMA-Fastrach/whistle technique: a brief review with case reports. Proc (Bayl Univ Med Cent). 2005;18(3):220-7.
Crosby ET, Cooper RM, Douglas MJ, Doyle DJ, Hung OR, Labrecque P, et al. The unanticipated difficult airway with recommendations for management. Can J Anaesth. 1998;45(8):757-76.
Rich JM, Mason AM, Bey TA, Krafft P, Frass M. The critical airway, rescue ventilation, and the combitube: Part 2. AANA J. 2004;72(2):115-24.
Rich JM, Mason AM, Bey TA, Krafft P, Frass M. The critical airway, rescue ventilation, and the combitube: Part 1. AANA J. 2004;72(1):17-27.
Rich JM, Mason AM, Ramsay MA. AANA journal course: update for nurse anesthetists. The SLAM Emergency Airway Flowchart: a new guide for advanced airway practitioners. AANA J. 2004;72(6):431-9.
Roberts JR, Wuerz RC. Clinical characteristics of angiotensin-converting enzyme inhibitor-induced angioedema. Ann Emerg Med. 1991;20(5):555-8.
Nayak KR, White AA, Cavendish JJ, Barker CM, Kandzari DE. Anaphylactoid reactions to radiocontrast agents: prevention and treatment in the cardiac catheterization laboratory. J Invasive Cardiol. 2009;21(10):548-51.
Olesen AL, Tollund C, Sondergaard I, Strom JJ. [Life-threatening angioedema associated with ACE inhibitor treatment]. Ugeskr Laeger. 2003 3;165(10):1041-2.
Stojiljkovic L. Renin-angiotensin system inhibitors and angioedema: anesthetic implications. Curr Opin Anaesthesiol. 2012;25(3):356-62.
Borum ML, Howard DE. Hereditary angioedema. Complex symptoms can make diagnosis difficult. Postgrad Med. 1998;103(4):251, 5-6.
Jason DR. Fatal angioedema associated with captopril. J Forensic Sci. 1992;37(5):1418-21.
Goss JE, Chambers CE, Heupler FA, Jr. Systemic anaphylactoid reactions to iodinated contrast media during cardiac catheterization procedures: guidelines for prevention, diagnosis, and treatment. Laboratory Performance Standards Committee of the Society for Cardiac Angiography and Interventions. Cathet Cardiovasc Diagn. 1995;34(2):99-104.
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