They could not obtain information regarding the presence of PTBP-F-R in the electrodes from the manufacturers. reported similar cases of contact dermatitis caused by ECG electrodes. From this phenomenon, it can be inferred that the substance contained on the adhesive side of the electrode differs depending on the product and that any substance contained in the BIS sensor can cause dermatitis.Īvenel-Audran et al. No skin reaction occurred when the ECG electrodes and eye patches were used at the same time. Patch testing did not help to identify the causative agent in this case. According to the manufacturer’s description, it is not entirely impossible for these substances to be included in the adhesive component, but it is generally improbable. Although PTBP-F-R is a commonly used ingredient in adhesives and lanolin is sometimes used as a moisturizer or drug base, to our knowledge, no medical accessories have been found that intentionally contained these substances. The results of the Japanese standard patch test series performed simultaneously suggested the possibility that PTBP-F-R or lanolin was the causative agent. In addition, this report is considered meaningful for examining future cases in which allergy cannot be denied because of the course of onset. ![]() From our patch test results, dermatitis in our case was confirmed to be a response to the BIS sensor content. Patch tests were not conducted in any cases, and no definitive diagnosis was made. Both examples were presumed to involve irritant contact dermatitis based on the acute onset on the day of surgery. One patient was in the prone position, and it could not be denied that the event was possibly caused by physical pressure. To our knowledge, there have been two reports of contact dermatitis associated with BIS sensors. In addition, the researchers presumed that these events were caused by the AgCl electrode or an external force such as a pulling force or the prone position. Previous reports of skin lesions caused by the BIS sensor observed spotted bleeding and erythema on the area in contact with the foam and blisters on the area in contact with the adhesive. The Ag-AgCl electrode is printed on polyester material, and acrylic adhesive and foam are attached to it. We experienced a case of contact dermatitis caused by a BIS sensor, and the results of our patch test identified the adhesive part of the sensor as the cause.īIS sensors are based on Zipprep™ technology for ensuring good skin contact and optimal signal quality. Erythema peaked on the fifth postoperative day and improved gradually thereafter.Ĭontact dermatitis associated with anesthesia can be attributable to ECG electrodes, Prone Positioner™, and contaminants on facemasks however, the incidence is low, and it often is impossible to sufficiently investigate the causes. The patient was administered topical steroids and antihistamines. She visited a dermatologist 5 days after surgery, and the anesthesiologist identified dermatitis (Fig. Three days after surgery, she felt itching sensations and burning pain and noticed erythema on her forehead. Subsequently, the patient was discharged from the hospital. The anesthesiologist made a postoperative round the morning after surgery and found no complications. The patient had no apparent skin reaction on postoperative day 1. No abnormal skin reaction was noted in the region surrounding the BIS sensors, ECG electrodes, and eye patches. After surgery, the eye patches and BIS sensor were removed in the operating room. During surgery, hydrocortisone 100 mg and acetaminophen 1000 mg were administered to prevent laryngeal edema and analgesia, separately. The durations of anesthesia and surgery were 85 and 43 min, respectively. We used eye patches (Nichiban, Tokyo, Japan) for eye protection during surgery. Anesthesia was maintained with desflurane and oxygen to ensure a BIS of 40–60. ![]() Propofol and remifentanil were used for induction, and rocuronium was used for nasal intubation. ![]() Immediately before induction, an electrode for the BIS monitor (BIS QUATRO Brain Monitoring Sensor, Medtronic, Dublin, Ireland) was attached in a routine manner after alcohol skin preparation as recommended by the manufacturer. In the operating room, electrocardiogram (ECG) electrodes (Vitorode L, Nihon Kohden, Tokyo, Japan) and other standard noninvasive ASA monitors were attached. She had no skin disease or history of allergy preoperatively, and she was receiving no medications. A 38-year-old female patient with American Society of Anesthesiologists (ASA) physical status 1 underwent tooth extraction under general anesthesia.
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