• Anaesth Intensive Care · Nov 2018

    Case Reports

    Epinephrine (adrenaline) preventing recovery from intraoperative anaphylactic shock complicated by systolic anterior motion of the mitral valve with left ventricular outflow tract obstruction on transoesophageal echocardiography.

    • Phm Sadleir, R C Clarke, Bsl Lim, and P R Platt.
    • Clinician, WA Anaesthetic Allergy Clinic; Senior Lecturer, Department of Pharmacology, University of Western Australia; Perth, Western Australia.
    • Anaesth Intensive Care. 2018 Nov 1; 46 (6): 566-571.

    AbstractWe describe a case of severe left ventricular outflow tract obstruction (LVOTO) with severe mitral incompetence due to systolic anterior motion of the anterior mitral leaflet (SAM) that was recognised thanks to the immediate availability of transoesophageal echocardiography during the resuscitation of anaphylactic shock. The patient rapidly responded to cessation of the epinephrine (adrenaline) infusion and intravascular volume expansion with intravenous crystalloid. The absence of risk factors for developing SAM/LVOTO serve as a warning to clinicians to consider this diagnosis in all cases of epinephrine non-responsive anaphylactic shock.

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