Recently we had a highly anxious 48-year-old female smoker present for an initial examination. Her medical history revealed serum disease as part of a sensitivity to narcotic agents. It was discovered during a hospitalization where she underwent general anesthesia for a routine surgery. Have you ever heard of this? Could this be a concern if we choose to use conscious sedation medications with her?
To be more specific, this patient reported that the serum disease was an allergic reaction to the muscle relaxants in the general anesthetic administered by an oral surgeon. I doubt this would be a problem with our class of drugs, but my instincts are telling me a call to her physician or to the oral surgeon would be prudent.
Dr. Leslie Fang, DOCS Education Faculty responds:
In all likelihood, the patient is trying to describe serum sickness.
Serum sickness is a disease complex following exposure to drugs or foreign proteins. The syndrome is most apparent after exposure to blood or blood products (hence the term serum sickness). Exposure to exogenous proteins is the most common trigger for serum sickness. The body produces antibodies which combine with these proteins to form immune complexes. These complexes can cause more reactions, and cause the symptoms detailed below. Serum sickness can also be caused by several drugs, notably penicillin-based medicines.
Serum sickness is a disease manifesting with joint symptoms, skin rashes, fever, and lymph node swelling. In severe instances, patients can actually develop shock.
In this patient, it is important to find out which drug is suspected to have caused the serum sickness since re-exposure can result in shock and anaphylactoid reaction. I would suspect that it is very unlikely to be related to any benzo-like compounds and is far more likely to be related to general anesthetic.
Dr. Anthony Feck, Dean of DOCS Education Faculty responds:
The only thing that I can add to our resident medical expert is that serum sickness is not an anaphylaxis reaction, but a delayed response. As Dr. Fang pointed out, it is almost certainly not a problem with benzodiazepines or benzodiazepine-like drugs. It would be prudent to do your research regarding this patient’s actual experience.
This blog post should never be considered a proper replacement for necessary training and/or education regarding adult oral conscious sedation. Regulations regarding sedation vary by state. This is an educational and informational piece.
