Hespan allergy?

[neuroride]

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Had a 26 yo girl today with spinal bifida come for a lap colostomy for chronic constipation. She said she was allergic to sulfa/PCN/lidocaine/Latex.

About 30 min. after the start, she was a little tachy (120's) and BP around 100/65. Deceided to give her some Hespan after 1 liter of fluid. I pushed in about 200 ml and heard the pulse ox ramp up, looked over to see HR at 180 and next BP was 60/40.

In the next 40 min., we gave epi/benadryl/decadron/vasopressin/phenylephrine just to get her back stable.

Anyone had issues with hetastarch/hespan like this? At our program, we have had 1 other patient with similiar issues like this.
Was wondering how common this may be.

 

[Jeff05]

have never seen it, but
http://www.anesthesia-analgesia.org/content/101/6/1709.full

 

[proman]

A fellow resident saw it. Adolescent scoliosis repair, got a bit hypotensive, gave Hespan, got more hypotensive, gave more Hespan etc. It's hard to pick up. Wasn't the kid's first exposure to Hespan but never got an allergy workup. I'd consider it very rare though.

 

[Curious Biff]

Any other potential offenders? Rocuronium? Antibiotics?

There can be a 20-30 minute delay between giving certain meds and having an anaphylactic/anaphylactoid reaction. In the one case of proven rocuronium allergy I've seen, it took about 20 minutes before it was manifested. It was subsequently verified later via skin testing.

Hetastarch would be low on my list. Not absent, but low. Just like someone who says they're allergic to an amide local anesthetic.

Biff