. Clinical Note
Laryngospasm after Administration of Gadopentetate Dimeglumine' James E. Omohundro, MD Few serious adverse reactions associated with the use of gadopentetate dimeglumine in magnetic resonance imaging have been reported. The present case involves an 8-year-oldgirl who developed laryngospasm after administration of gadopentetate dimeglumine. Index terms: Contrast mhancenieiit * Gadolinium * Larynx, stenosis or obstrurlion. 2'71 469. 271.99 Safely
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JMRll992; 2:729-730
Marcia K. Elderbrook, BSN
NAUSEA, VOMITING, urticaria, facial edema, difficulty breathing, bronchial spasm, hypotension, and many other adverse effects are well-documented complications attributed to iodinated contrast media used in many radiologic procedures ( 1). However, few serious adverse reactions have been reported with the use of contrast media in magnetic resonance (MR)imaging (product insert, 1989, Berlex Laboratories, Wayne, NJ). We report a case of laryngospasm after administration of gadopentetate dimeglumine (Magnevist; Berlex Laboratories) in an 8-year-old girl. 0
'
From the University of Wisconsin Children's Hospital, CSC H41431.600 Highland Ave. Madison. WI 53792. Received March 3. 1992: relision reqnested April 2. revisiori rereived arid accepted Angust 18 Address reprint requests to T.V.R. '
SMRI. 1992
Thomas V. Ringer, MD
CASE REPORT
The patient was an 8-year-old girl with scoliosis and seizure disorder. She was evaluated in our pediatric sedation clinic immediately before MR imaging of the spine and head. She had been seizure-free on divalproex sodium (Depakote: Abbott Laboratories, North Chicago, Ill) and had no known drug or other allergies. There was no recent history of cough, rhinorrhea, fever, vomiting, or diarrhea, nor was there history of respiratory problems or airway obstruction. Examination revealed normal oral, pharyngeal, and mandibular anatomic characteristics. The neck was without masses, and the trachea was midline. The lungs were clear. No gross thoracic abnormality was noted. A peripheral intravenous catheter was placed in the right arm. Pentobarbital at a dose of 4 mg/kg was administered via the catheter, and a midazolam (Versed; Roche Laboratories, Nutley, N J ) infusion at 2.5 pglkgimin was started, with apparent sedation achieved within 5 minutes. The respiratory rate was 24 breaths per minute, the heart rate was 9 4 beats per minute, and saturation by pulse oximetry was 98%. The patient was transported to the MR imaging suite and placed in a supine position in the imager. She awoke, and pentobarbital at a dose of 2 mg/kg was administered. Imaging
was started, and the patient was monitored clinically by means of t-ital signs and saturation levels recordcd every 5 minutes. Fifty-five minutes after imaging was started, 5 mL of gadopentetate dimeglumine (0.1 mmol/kg) was injected intravenously, and the patient was repositioned for cervical spine imaging. Thirty minutes later, she developed acute inspiratory stridor with deep retractions, duskiness of the lips, and pulse oximetry saturation levels of 86%. Head repositioningand jaw thrust did not relieve the obstruction. Bag mask ventilation with 100%oxygen met with some resistance. Inspiratory stridor was auscultated at the neck; however, the lung sounds remained clear. The blood pressure was 120/80 m m Hg. and the heart rate 120 beats per minute. A volume of 0.3 mL of 1: 1.000 epinephrine was administered subcutaneously, owing to the intravenous catheter infiltrating. Bag mask ventilation was discontinued shortly thereafter. with mild residual inspiratory stridor and good air movement into the lungs. Saturation levels returned to 100%with blowby oxygen. MR imaging was aborted, arid the patient was returned to the sedation recovery room for close monitoring and observation. During the episode of airway obstruction, the patient had initial facial pallor followed by flushing. There was no sign of swelling of the eyelids, lips. or tongue, and no generalized urticaria or edema was noted. No stridor was apparent while the patient was asleep in recovery: however, mild inspiratory stridor was noted when she was awake and crying. The stridor resolved completely in less than a hour, and the patient was discharged home after further observation. DISCUSSION Adverse reactions occurring with intravenously administered iodinated contrast agents are familiar to all radiologists; however, serious events after 0
729
administration of MR imaging enhancing media are rare. The most common adverse reactions seen with gadopentetate dimeglumine are headache (4.9%), nausea (3.4%).vomiting [ < 2 % ) ,and injection site discomfort I
Laryngospasm after Administration of Gadopentetate Dimeglumine' James E. Omohundro, MD Few serious adverse reactions associated with the use of gadopentetate dimeglumine in magnetic resonance imaging have been reported. The present case involves an 8-year-oldgirl who developed laryngospasm after administration of gadopentetate dimeglumine. Index terms: Contrast mhancenieiit * Gadolinium * Larynx, stenosis or obstrurlion. 2'71 469. 271.99 Safely
-
JMRll992; 2:729-730
Marcia K. Elderbrook, BSN
NAUSEA, VOMITING, urticaria, facial edema, difficulty breathing, bronchial spasm, hypotension, and many other adverse effects are well-documented complications attributed to iodinated contrast media used in many radiologic procedures ( 1). However, few serious adverse reactions have been reported with the use of contrast media in magnetic resonance (MR)imaging (product insert, 1989, Berlex Laboratories, Wayne, NJ). We report a case of laryngospasm after administration of gadopentetate dimeglumine (Magnevist; Berlex Laboratories) in an 8-year-old girl. 0
'
From the University of Wisconsin Children's Hospital, CSC H41431.600 Highland Ave. Madison. WI 53792. Received March 3. 1992: relision reqnested April 2. revisiori rereived arid accepted Angust 18 Address reprint requests to T.V.R. '
SMRI. 1992
Thomas V. Ringer, MD
CASE REPORT
The patient was an 8-year-old girl with scoliosis and seizure disorder. She was evaluated in our pediatric sedation clinic immediately before MR imaging of the spine and head. She had been seizure-free on divalproex sodium (Depakote: Abbott Laboratories, North Chicago, Ill) and had no known drug or other allergies. There was no recent history of cough, rhinorrhea, fever, vomiting, or diarrhea, nor was there history of respiratory problems or airway obstruction. Examination revealed normal oral, pharyngeal, and mandibular anatomic characteristics. The neck was without masses, and the trachea was midline. The lungs were clear. No gross thoracic abnormality was noted. A peripheral intravenous catheter was placed in the right arm. Pentobarbital at a dose of 4 mg/kg was administered via the catheter, and a midazolam (Versed; Roche Laboratories, Nutley, N J ) infusion at 2.5 pglkgimin was started, with apparent sedation achieved within 5 minutes. The respiratory rate was 24 breaths per minute, the heart rate was 9 4 beats per minute, and saturation by pulse oximetry was 98%. The patient was transported to the MR imaging suite and placed in a supine position in the imager. She awoke, and pentobarbital at a dose of 2 mg/kg was administered. Imaging
was started, and the patient was monitored clinically by means of t-ital signs and saturation levels recordcd every 5 minutes. Fifty-five minutes after imaging was started, 5 mL of gadopentetate dimeglumine (0.1 mmol/kg) was injected intravenously, and the patient was repositioned for cervical spine imaging. Thirty minutes later, she developed acute inspiratory stridor with deep retractions, duskiness of the lips, and pulse oximetry saturation levels of 86%. Head repositioningand jaw thrust did not relieve the obstruction. Bag mask ventilation with 100%oxygen met with some resistance. Inspiratory stridor was auscultated at the neck; however, the lung sounds remained clear. The blood pressure was 120/80 m m Hg. and the heart rate 120 beats per minute. A volume of 0.3 mL of 1: 1.000 epinephrine was administered subcutaneously, owing to the intravenous catheter infiltrating. Bag mask ventilation was discontinued shortly thereafter. with mild residual inspiratory stridor and good air movement into the lungs. Saturation levels returned to 100%with blowby oxygen. MR imaging was aborted, arid the patient was returned to the sedation recovery room for close monitoring and observation. During the episode of airway obstruction, the patient had initial facial pallor followed by flushing. There was no sign of swelling of the eyelids, lips. or tongue, and no generalized urticaria or edema was noted. No stridor was apparent while the patient was asleep in recovery: however, mild inspiratory stridor was noted when she was awake and crying. The stridor resolved completely in less than a hour, and the patient was discharged home after further observation. DISCUSSION Adverse reactions occurring with intravenously administered iodinated contrast agents are familiar to all radiologists; however, serious events after 0
729
administration of MR imaging enhancing media are rare. The most common adverse reactions seen with gadopentetate dimeglumine are headache (4.9%), nausea (3.4%).vomiting [ < 2 % ) ,and injection site discomfort I
