Intraoperative transoesophageal echocardiographic detection of a retained surgical sponge.

but tolerated the semi-synthetic analogue: nalbuphine (in vivo administration). Although meperidine can cause pseudo-allergic reaction, therefore 'false' positive prick tests, our patient's strong skin reaction compared with control persons indicated a true hypersensitivity (Fig. 1). The case demonstrates the importance of drug allergy examinations in perioperative anaphylaxis and the existence of rare fentanyl and propofol induced severe reactions. Our patient's case was further complicated by the patient's hypersensitivity to the non-barbiturate-type sedative propo-fol, which likely contributed to the onset of anaphylaxis during anaesthesia. Patients who experience perioperative anaphylaxis need a thorough examination for drug allergy. The evaluation should include a precise clinical history, consideration of risk factors, and in vitro and in vivo drug allergy tests. 1 Whittington T, et al. Anaphylactic and anaphylactoid reactions. 4 Laroche D, et al. Biochemical markers of anaphylactoid reactions to drugs. Comparison of plasma histamine and tryptase. Anesthe-siology 1991; 75: 945– 9 5 Société Francaise d'Anesthesie et de reanimation. Reducing the risk of anaphylaxis during anaesthesia. Editor—We report a case where a retained surgical sponge after aortic valve replacement was detected using intra-operative transoesophageal echocardiography having allowed immediate diagnosis and its removal. A 66-yr-old patient was admitted for aortic valve replacement. He had a long history of aortic stenosis and regurgita-tion. Preoperative angiography showed a 40% left ventricular ejection fraction and an enlargement of the left ventricular cavity. Coronary angiogram was normal. Anaesthesia was LA S LV 0 Fig 1 Mid-oesophageal four-chamber view at 08 showing the sponge in the left ventricle.