Table 1 Chronological presentation of the events that occurred during endoscopic examination
From: Anaphylaxis caused by butylscopolamine bromide: a case report
Elapsed time (min) | Events | Vital signs and laboratory data |
|---|---|---|
− 8 | Pronase® (protease from Streptomyces griseus) and Gascon® (dimethicone) syrup were given orally as pre-medication. | |
− 1 | The patient’s throat was sprayed with 8% lidocaine. | HR 69 bpm, BP 96/51 mmHg, SpO2 97% |
0 | Butylscopolamine bromide 10 mg was administered intravenously to minimize gastrointestinal movement. Flunitrazepam 0.2 mg and pethidine hydrochloride 17.5 mg were given intravenously for mild sedation. | |
1 | Endoscopic examination commenced. | |
6 | Since facial cyanosis was observed, 4 L/min oxygen administration was started. | HR 144 bpm, BP 70/42 mmHg, SpO2 82% |
8 | Endoscopic examination was stopped. | HR 140 bpm, BP unmeasurable, SpO2 72% |
10 | Flumazenil 0.2 mg was administered and a code blue was called. | HR, SpO2, and BP undetectable |
12 | The anesthesiologist arrived at the endoscopy center. | |
13 | Endotracheal intubation was performed. Adrenaline 0.3 mg was administered intravenously. | |
19 | BP partially recovered and SpO2 transiently improved. | HR 132 bpm, BP 65/30 mmHg, SpO2 90% |
27 | The patient was transferred to the post-anesthesia care unit. | |
28 | Additional adrenaline 0.3 mg was administered. | |
37 | A saline solution was rapidly infused, and hydrocortisone 100 mg was intravenously administered. Spontaneous respiration was assisted with 5 cm H2O CPAP at an FiO2 of 0.5. | HR 125 bpm, BP 76/47 mmHg, SpO2 94%, PaO2 197 mmHg PaCO2 49 mmHg, BE 0.9 mmol/L |
42 | Light systemic skin rashes were observed on the patient’s body. | |
57 | Blood samples were collected to measure plasma histamine and serum tryptase levels. | Histamine 271.7 nmol/L, tryptase 174 μg/L |
77 | The patient’s trachea was extubated. | HR 110 mmHg, BP 103/44 mmHg, SpO2 99% |