Intraoperative anaphylactic shock caused by TachoSil<sup>®</sup> tissue sealing sheet - Case report

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  • Ishida Hiroto
    Department of General Thoracic Surgery, Osaka International Cancer Institute Department of General Thoracic Surgery, Osaka University Hospital
  • Okami Jiro
    Department of General Thoracic Surgery, Osaka International Cancer Institute
  • Susaki Yoshiyuki
    Department of General Thoracic Surgery, Osaka International Cancer Institute
  • Kusu Takashi
    Department of General Thoracic Surgery, Osaka International Cancer Institute
  • Tokunaga Toshiteru
    Department of General Thoracic Surgery, Osaka International Cancer Institute
  • Higashiyama Masahiko
    Department of General Thoracic Surgery, Osaka International Cancer Institute

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  • タコシール<sup>Ⓡ</sup>組織接着用シートによる術中アナフィラキシーショックの1例

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Abstract

<p>A 61-year-old male underwent a right middle lobectomy for lung cancer. During the operation, two pieces of TachoSil® sealant sheets were used, one approximately 1 cm2 and the other approximately 22 cm2 placed one hour later. Approximately 10 minutes after use of the second sheet, the systolic blood pressure dropped sharply to about 40 mmHg, the response to vasopressor administration was poor, and the low blood pressure state continued. No active bleeding was observed in the operative field, while flushing and rash were observed on the face, neck, and upper arm. Thus, it was diagnosed as anaphylactic shock. We considered that TachoSil® was the causative agent; thus, both sheets were removed and the attachment areas were lavaged with saline. After about 10 minutes, the blood pressure was restored and response to the vasopressor was improved. A drug-induced lymphocyte stimulation test (DLST) was positive. Therefore, we concluded that anaphylactic shock due to TachoSil® use had occurred in our patient during surgery. TachoSil®-induced anaphylactic shock is very rare, and we report this case to alert surgeons to its possible occurrence.</p>

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