Combine midazolam-fentanyl-ketamin for evisceration surgery in patient with multidrug allergy in acute on chronic exacerbation of hypersensitivity reaction

Abstract

A multidrug allergy is a relatively rare immunology abnormality. Generally, it is caused by a congenital genotype and influenced by the environment. After treating the acute symptoms of chronic exacerbation of hypersensitivity type 1, the inflammation can alleviate and the patient will need to be scheduled for evisceration oculi dextra with general anaesthesia. The ophthalmologist was curious about the procedure because evisceration requires an antibiotic to wash the oculi, but there was no antibiotic available for the patient. With respect to general anaesthesia, the patient had no history and therefore we could not predict an allergy to the anesthetic drug. We chose to combine ketamine-midazolamfentanyl to facilitate the anaesthesia. Ketamine significantly reduces the production of inflammatory cytokines without affecting the production of anti-inflammatory cytokines. Fentanyl is an opioid that rarely causes allergy and has strong potential. Finally, midazolam can help the sedation.

Keywords

• allergy
• multidrug
• fentanyl
• ketamine
• midazolam