Life threatening non-allergic reaction to general anaesthetic

In November  2014 I had a stomach upset, bad enough to go to my GP who administered a cocktail of injections to alleviate nausea, sickness, diahorrea and 4 days worth of dehydration. A few minutes afterwards, my mouth was tingling, I felt sick and faint and could not breath. My pulse went from normal 50bpm to 132, oxygen to 72 and bp to 50/30. My veins collapsed, but the GP managed to get me on oxygen, injected cortizone and adrenalin and the IV for fluids was finally inserted in the ambulance en route to the hospital. 

I spent the next 4 days in ICU, where I stabilised in the first day. Allergic reaction to the drugs was considered but rejected, as the same drugs were given by IV in hospital (it was later determined they were prescribed but not given). My collapse was diagnosed as hypovolemic shock. All organs were checked for damage arising from the oxygen deprivation. Everything was clear but I remained dizzy, unbalanced with moderate headache, so was examined by an orthapaedic specialist who arranged a CT scan of my neck and head.

The CT scan revealed cervical spondylosis; an unrelated condition, which I was glad to have diagnosed as it explained some neurological symptoms I had been experiencing over the previous year. The neurosurgeon confirmed early myelopathy and corrective spinal surgery was scheduled for December 2014.

Several checks were made beforehand to ensure I was fit for surgery; ecg, pulmonary function, ecg & ultrasound and discussion with anesthesiologist. As I have a slight allergy to cats and sometimes use a ventolin inhaler, I was put on a cortisone inhaler and was to be given a nebuliser along with the pre med. The anesthetic team would monitor me after general anesthetic (GA) was administered to ensure I was stable before surgery commenced.

I came round c24 hours after entering theatre to find myself in the coma ward with all the consultants around me. It seems that despite all the precautions and 30 mins monitoring after GA, the surgeon was about to make the incision when I went into bronchiospasm. I am told my blood pressure and heart rate dropped to dangerously low. I suffered a minor cardio infraction, my lungs filled with fluid and oxygen level fell to near zero. I am not sure how they saved me from this situation, but thankfully I am here to tell the tale.

The next 4 days in ICU were a slow, hard and shocking recovery both physically and emotionally. Lungs and heart were constantly monitored. I had 2 quite different skin reactions that were attended to by a pulmonarist checking for DVT and dermatologist treating and trying to ascertain cause. One reaction was skin splits on my inner forearm that had white crusty edges. The one on my inner calf started with bruising and developed into large blisters after 3 days.

The consensus was massive allergic reaction, most likely linked to the first collapse. I was sent home to recover over the holiday season. Despite the trauma and in the case of the heart some minor irreparable damage, my pulmonary function test and stress ecg showed a return to pre theatre levels - even better in the case of the lungs.

Allergy tests were scheduled. Two drugs were common in both instances (Elitan/Primperan & Zantac). Such was the concern of the consulting team that the subcutaneous skin tests were run in ICU, linked up to IV and all monitors. However, even an undiluted sample of the suspected trigger did not give a clear, positive result. All drugs and materials were tested, with no conclusive result.

A Rheumatologist was called in to discuss the possibility of an auto immune disease, but blood tests for these also returned negative. By now my arm had healed, the blisters on my calf burst and resulting deep tissue necrosis had to be removed. A biopsy was taken at the same time, which suggested the cause could be drug related.

I was advised to seek further opinions and consider an “underlying condition". So I consulted with specialists and renowned world experts throughout Europe, the UK and US. Some said they had no expertise in the area, some said retest & challenge and one was quite incredulous stating there is little evidence of allergy to the 2 drugs.

I finally found an allergist who explained the concerns in terms I understand; Something triggered my collapses and the reactions that then occurred. If it was something I was allergic to, then I would have produced antibodies which will respond again to the introduction of the trigger. There was no such reaction in the testing, therefore I am not allergic to any of the drugs or materials used. However, I could have an intolerance/sensitivity that causes my system to react to a trigger, meaning no production of antibodies, necessitating another approach to testing.

The responses in my system on both occasions are described as a sudden difference between the volume of blood and the capacity of my circulatory system. The body tries to address this by finding fluid and in so doing fills the lungs, small vessels burst, blood pressure drops, heart is overworked etc…

I have been advised to have no medical intervention until this is resolved – unless I have an equally life threatening situation arise.

I have now been referred to a toxicology clinic in Athens (I live in Cyprus) who will liaise with specialist centres in France & Switzerland. They will be investigating underlying conditions, possibly genetic (my son had an unexplained reaction to GA many years ago). A helpful person on another thread shared her similar experience and diagnosis (malignant hyperthermia) and this may be a first step in the investigation.

I have found very little on reactions to GA or non allergic reactions to drugs and would be very grateful if anyone can offer insights here.

Thanks for sharing this journey!

Carol

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