# A Case of Anaphylactic Shock Suspected to Be Caused by Bovine Serum Albumin Tissue Adhesive (BioGlue) During Thoracoabdominal Aortic Replacement

## TL;DR

A patient had an anaphylactic reaction during surgery due to a tissue adhesive made from bovine serum albumin, highlighting its potential as an allergen.

## Contribution

Highlights the rare but serious risk of anaphylaxis from bovine serum albumin tissue adhesive during surgery.

## Key findings

- A patient experienced intraoperative anaphylaxis after BioGlue application, showing hypotension and airway edema.
- BioGlue contains bovine serum albumin, which can act as an allergen despite rare reports of anaphylaxis.
- Prompt recognition of allergens like BioGlue is crucial during intraoperative shock.

## Abstract

Bovine serum albumin (BSA) tissue adhesive (BioGlue, Cryolife Inc., Kennesaw, GA, USA) is often used as a hemostatic adjunct in adult patients undergoing open surgical repair of large vessels, such as the aorta, femoral, and carotid arteries. We present a case of intraoperative anaphylaxis attributed to the use of BioGlue during thoracoabdominal aortic replacement. The patient suddenly developed hypotension, hypoxemia, and airway edema after the BioGlue application. BioGlue is composed of purified BSA and glutaraldehyde. Despite the BSA component being an allergen that can cause anaphylaxis in some patients, reported occurrences of anaphylaxis are extremely rare. We need to recognize BSA tissue adhesive as a potential allergen. In the event of an intraoperative shock, prompt recognition and investigation of the underlying cause are necessary.