Anaphylactic shock after cosmetic injection of anesthetic.

The Central Military Hospital 108 recently admitted a 44-year-old female patient to the emergency room in a state of severe fatigue, chest tightness, and shortness of breath. These symptoms appeared after she received a local anesthetic (Lidocaine) injection for a nose filler procedure at an unlicensed spa.

At the Emergency Department of Military Central Hospital 108, doctors checked the patient's vital signs and found low blood pressure and inadequate blood oxygen saturation.

To ensure safety, people should seek out reputable medical facilities. The person administering filler injections must be a trained physician with sufficient knowledge of anatomy and cosmetic surgery, and possess a professional license.

The patient was immediately diagnosed with suspected grade III anaphylaxis with Lidocaine and treated simultaneously according to both anaphylaxis and anesthetic toxicity protocols, using the vasopressor adrenaline and 20% lipid emulsion along with other resuscitation measures.

After the patient's condition stabilized, they were transferred to the Internal Medicine and Toxicology Intensive Care Unit, Intensive Care Center, Military Central Hospital 108 for continued monitoring and treatment.

During treatment, the patient developed severe multi-organ damage (respiratory, myocardial, liver, coagulation disorders), requiring the combination of multiple vasopressors at progressively higher doses, with a high risk of death.

According to Dr. Nguyen Tien Son, a specialist in the Emergency Department of the Central Military Hospital 108, the patient was fortunate to receive proper, timely, and proactive emergency care, thus avoiding unfortunate consequences.

Therefore, when people need cosmetic procedures, they should choose reputable cosmetic facilities licensed by the Ministry of Health and with a team of experienced anesthesiologists and resuscitation specialists. They should also equip themselves with basic knowledge about the signs of anaphylaxis to local anesthetics.

Dr. Son warned that many unlicensed facilities currently exist, where practitioners lack proper training and even medical expertise, yet brazenly perform invasive procedures on clients. Therefore, the risk of complications is high.

Recently, medical facilities have recorded many cases of cosmetic surgery complications resulting from these unlicensed spas, mostly due to the desire for cheap prices and believing enticing offers online, leading to financial loss and health problems. Among patients admitted with complications after beauty treatments, complications from filler injections account for a relatively large number.

Anaphylaxis is an allergic reaction that can appear immediately, from seconds, minutes to hours after the body comes into contact with an allergen, causing various clinical manifestations, and can be severe, leading to rapid death.

Some symptoms suggestive of anaphylaxis include: hives, rapid angioedema; shortness of breath, chest tightness, wheezing; abdominal pain or vomiting; hypotension or fainting; altered consciousness.

Anaphylaxis during anesthesia or surgical anesthesia is often difficult to diagnose because the patient is already anesthetized and sedated, and skin symptoms may not appear, making it difficult to assess subjective signs.

Therefore, a thorough allergy history should be obtained before administering anesthesia or surgical sedation, and symptoms such as hypotension, decreased blood oxygen levels, tachycardia, new-onset wheezing, and changes on the monitor should be carefully assessed.

Some anesthetics are lipophilic substances with high toxicity when introduced into the body, causing severe poisoning similar to anaphylaxis that can be fatal within minutes. Emergency treatment with antitoxins (lipid emulsions) combined with adrenaline is necessary because the mechanism of the reaction—whether it is poisoning or an allergy—cannot be determined immediately.

In addition to acting as a vehicle to remove anesthetic drugs from high-blood-flow organs most sensitive to systemic anesthetic toxicity and redistributing them to storage and detoxification organs, lipid emulsions also improve cardiac contractility, cardiac output, blood flow, and blood pressure through their effects on blood vessels and the heart, activating protective cardiovascular pathways.

Therefore, patients need to be aware of the early signs of anaphylaxis to local anesthetics so that they can seek timely emergency care at the nearest medical facility if it occurs.

Regarding complications after filler injections, the Vietnam-Germany Friendship Hospital recently received a case of Ms. NCT (31 years old, from Quang Nam province ) who came to the hospital with bilateral breast abscesses due to breast filler injections.

Associate Professor Dr. Nguyen Hong Ha, Head of the Department of Plastic and Aesthetic Surgery at Viet Duc Friendship Hospital, said that the patient arrived at the hospital in a state of infection and toxicity. Clinical examination of the breasts revealed numerous lumps of varying sizes throughout both breasts.

However, conventional ultrasound results do not clearly show the location of these masses, so doctors had to order a specialized 3.0 Breast Coil MRI scan.

On these state-of-the-art mammograms, doctors have identified numerous masses in the breast resembling "filler lumps," forming multiple layers and scattered throughout the breast, both within the mammary glands and, more dangerously, in many locations within the pectoralis major muscle.

The patient was diagnosed with a breast abscess with numerous high-risk filler-filled tumors due to breast filler injections and filler aspiration, which allowed external bacteria to enter the body. Ms. T.'s symptoms of fever and chills indicated that the abscesses were at risk of rupturing, and if they spread to the lungs, it would be life-threatening.

Another case of cosmetic surgery complications requiring emergency treatment at Viet Duc Friendship Hospital is Ms. D.N.N. (30 years old, from Ha Tinh). Ms. N. currently lives and works in Japan.

She went to a beauty spa in Japan to get filler injections. After only 0.5cc was injected into the middle of her forehead, she experienced drooping eyelids, dizziness, nausea, and vomiting.

Ms. N. was immediately given an antidote, but she still felt unwell and nauseous. That afternoon, she went to the hospital for a check-up. The doctor examined her, made no further intervention, and advised her to monitor her condition at home, saying it would improve after a month.

But she became even more worried when the next day she noticed her eye was much redder. She went to the hospital for emergency treatment, where her eye was swollen, under high pressure, and she could no longer see clearly. The following day, she experienced much more pain; the conjunctiva and cornea were swollen and filled with blood. Her eye was almost completely blind and seemed as if it were about to fall out.

Overwhelmed with worry about her condition, she decided to book a flight back to Vietnam for treatment. Upon returning to Vietnam, Ms. N. went to an eye hospital, and then transferred to Viet Duc Friendship Hospital six days after receiving filler injections.

Associate Professor Dr. Nguyen Hong Ha stated that the patient arrived at the hospital with the right eye swollen, tense, and purplish-red, with almost complete loss of vision, only able to distinguish between light and dark with difficulty, noticeable ptosis, and complete paralysis of the inner eye muscles.

Doctors determined this was a very severe case of complications following filler injection, affecting the blood vessels of the eye and leading to loss of vision in the right eye, along with signs of necrosis of muscle and tissue around the eyeball. The hospital's multidisciplinary emergency response protocol was immediately initiated.

The patient was immediately given injections of medications to reduce orbital pressure, vasodilators, and improve tissue circulation, high-dose oxygen therapy, and a combination of two systemic antibiotics.

And a series of state-of-the-art paraclinical and imaging tests were performed immediately. The imaging results showed that the patient's retina was 2-3 times more edematous than normal, the medial extraocular muscle and periorbital fat showed signs of ischemia and edema with a risk of complete necrosis. Arterial blood flow to the orbit of the right eye was significantly reduced compared to the healthy eye.

Regarding complications following filler injections, according to Dr. Nguyen Thi Huong Giang, a member of the emergency team at Viet Duc Friendship Hospital, when the person injecting the filler is not a specialist doctor, lacks knowledge of cosmetic surgery, and is especially just a spa employee, the risk of injecting into blood vessels around the eye socket is very high.

The medication will travel through the bloodstream to the brain. If a cerebral artery is blocked, it can cause a life-threatening stroke. If the ophthalmic artery, especially the central retinal artery, is blocked, it can cause blindness. The skin, muscle, and fat surrounding the blood supply of the branches of the vessels around the eye socket will also necrose, causing severe facial disfigurement.

Because the central retinal artery lacks the extensive anastomotic network found in the skin, once it becomes blocked, necrosis of nerve cells leading to blindness occurs very quickly.

Experts advise that, to ensure safety, people should seek out reputable medical facilities. The person administering filler injections must be a doctor who is trained and has sufficient knowledge of anatomy and cosmetic surgery, and holds a professional license.

In addition, it is necessary to choose filler products from reputable sources that have been verified for safety and purity. After injection, patients need to be monitored and receive timely treatment to avoid any unfortunate consequences.

In the unfortunate event of complications during a cosmetic procedure, it is crucial to transport the patient to a hospital with modern equipment and a comprehensive multidisciplinary emergency response protocol to ensure the most effective treatment.

Currently, even globally, only two or three major centers are capable of implementing a multidisciplinary emergency procedure to help patients recover their vision after vascular complications following filler injections.

Due to the increasing prevalence and difficulty in managing filler injections, the number of patients experiencing blindness complications is rising, with hundreds of cases estimated to have been recorded worldwide.

However, only a very small number of cases have seen doctors successfully restore vision, as seen at Viet Duc Friendship Hospital. Many people, including doctors and medical staff worldwide, are unaware of or do not believe that this complication can be treated.

Therefore, many patients are transferred to the emergency room late, and even stroke patients abroad rarely receive proper and adequate emergency care.

Source: https://baodautu.vn/soc-phan-ve-sau-tiem-thuoc-te-lam-dep-d225487.html