AB222. SOH21AS151. Severe intra-operative anaphylactic reaction to co-amoxiclav despite having a previous uneventful exposure

Abstract: Co-amoxiclav is used as a routine prophylactic antibiotic in surgical procedures. We present a case of a 45-year-old lady who was scheduled for elective repair of incisional hernia. Her past medical history was controlled hypertension with no previous drug or food allergy. On reviewing her past anaesthetic sheet, she was tolerant to the antibiotic with no reaction. In addition, on further questioning, she did mention receiving Co-amoxiclav several times orally without any complication. On the day of surgery, after induction of anaesthesia, the patient was given 1.2 g of Co-amoxiclav as per hospital protocol. Within 10 minutes, the patient developed severe bronchospasm with increased airway pressure and severe hypotension indicating anaphylactic shock. The patient was resuscitated and recovered successfully. The surgery was cancelled and the patient was provided a bed in the high dependency unit (HDU) for overnight monitoring and further investigations. Every theatre or ward that admit antibiotic should have a clear protocol for management of anaphylactic shock. Availability of adrenaline and timely delivery of the drug plays a core role in successful management of anaphylaxis.

Keywords: Co-amoxiclav; bronchospasm; airway pressure; hypotension; anaphylactic shock; adrenaline