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In Kounis Zavras syndrome, vasospastic mediators released from mast cells as response to allergic stimulus lead
to coronary vasospasm and results in acute coronary syndrome or angina pectoris. In this case report, anesthesia management
in a 35 year old female patient with Kounis Zavras syndrome who had Samter triad and multiple drug allergy and had arrest
previously due to drug allergy and hence who has implantable cardioverter defibrillator is presented.
A 35 year old female patient who had multiple drug allergy, Samter triad and Brittle asthma was referred to emergency
service with a picture of angioedema. It was learned that in the history of this patients Brittle asthma and Samter syndrome were
present as well as mitral failure and that in France allergic reaction developed to drugs used both for mitral failure and drug
allergy treatment and cardiac arrest developed. It was also learned that the patient was diagnosed with Brittle asthma, samter
period and Kounis-Zavras syndrome and implantable cardioverter defibrilator was placed. The list of the drugs to which the
patients is allergic was obtained from the relatives of the patient. During follow up in intensive care, she had anaphylactic picture
repeatedly. As the duration of intubation was over 7 days and anaphylaxy and edema. Picture recurred frequently, tracheotomy
was opened. During intensive care monitorization, aseptic femur necrosis developed owing to high dose methylprednisolone
administration, and operation was planned by orthopedics department. As she was known to be allergic to all kinds of local
anesthetics, general anesthesia was planned. Since the patients was not allergic to egg and soy, 4 mg/kg propofol, fentanyl 2
mcg/kg iv was administered. Muscle relaxants were not administered as she was allergic to them. After induction, patients
were connected to mechanical ventilation from tracheotomy canule and remifentanil and propofol infusion was initiated. No
anesthetic gas was used and operation was completed without any complications.
The incidental coincidence of chest pain and allergic reaction was defined by Kounis and Zavras in 1991. In these
cases, clinical and laboratory findings produced by inflammatory mediators released against allergic condition support the
presence of Angina Pectoris. At present, Kounis Zavras syndrome has replaced the terms of allergic angina pectoris or allergic
The management of these allergic angina pectoris syndromes involves the simultaneous treatment of acute coronary syndrome
and allergic syndrome. Our patient responsed to this treatment. In our patient, diagnosed Brittle asthma, Samter triad and Kounis
Zavras syndrome were present.
I. Ozkan Onal has completed his medical education from Ankara Gazi University Medical School and he has completed his anesthesia training from
Ankara Hacettepe University Medical School and he is working in Ankara Yuksek Ihtisas training and educational hospital. He has published more
than 15 papers about anesthesia.
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