Introduction - Perioperative anaphylaxis is a hypersensitivity reaction that occurs after exposure to drugs used for anaesthesia during a surgical procedure. The most common triggers are neuromuscular blocking agents and antibiotics. Case report - A 71-old man, with a history of anaphylaxis during previous anaesthesia, was scheduled for elective coronary surgery. The clinical signs included skin rash, swelling of the upper part of the body with angioedema of the eyelids and lips, without bronchospasm. Based on the assumption that rocuronium was the most likely causative agent, percutaneous coronary intervention was performed during the same hospitalization. After recovery, he was sent for a prick skin test and intradermal test, where sensitivity to rocuronium and insensitivity to the anaesthetics used were determined. Two months later, he developed an acute myocardial infarction. Chronic total occlusive percutaneous coronary intervention was attempted, but without optimal results, so the patient was prepared for elective surgery. Due to potential further complications during anaesthesia, the medical team decided to send him for a skin allergy test for neuromuscular blocking agents. The only neuromuscular relaxant available was Cisatracurium, and it was tested for sensitivity by intradermal test. The intradermal test showed insensitivity to Cisatracurium and Suxamethonium chloride. Conclusion - Early recognition and management of anaphylaxis is based on clinical presentation. The diagnosis by in-vivo and in-vitro tests is useful to determine the cause of anaphylactic reaction and safe alternatives for future anaesthesia.
| Published in | American Journal of Internal Medicine (Volume 9, Issue 6) |
| DOI | 10.11648/j.ajim.20210906.12 |
| Page(s) | 253-256 |
| Creative Commons |
This is an Open Access article, distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution and reproduction in any medium or format, provided the original work is properly cited. |
| Copyright |
Copyright © The Author(s), 2021. Published by Science Publishing Group |
Rocuronium, Anaphylaxis, Perioperative Period, Drug Hypersensitivity, Anesthesia, Signs and Symptoms, Skin Tests, Cisatracurium
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APA Style
Ivana Stojanovic, Jelena Vuckovic, Matej Suntic. (2021). Diagnosis and Management of Rocuronium-induced Perioperative Anaphylaxis. American Journal of Internal Medicine, 9(6), 253-256. https://doi.org/10.11648/j.ajim.20210906.12
ACS Style
Ivana Stojanovic; Jelena Vuckovic; Matej Suntic. Diagnosis and Management of Rocuronium-induced Perioperative Anaphylaxis. Am. J. Intern. Med. 2021, 9(6), 253-256. doi: 10.11648/j.ajim.20210906.12
AMA Style
Ivana Stojanovic, Jelena Vuckovic, Matej Suntic. Diagnosis and Management of Rocuronium-induced Perioperative Anaphylaxis. Am J Intern Med. 2021;9(6):253-256. doi: 10.11648/j.ajim.20210906.12
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Download@article{10.11648/j.ajim.20210906.12,
author = {Ivana Stojanovic and Jelena Vuckovic and Matej Suntic},
title = {Diagnosis and Management of Rocuronium-induced Perioperative Anaphylaxis},
journal = {American Journal of Internal Medicine},
volume = {9},
number = {6},
pages = {253-256},
doi = {10.11648/j.ajim.20210906.12},
url = {https://doi.org/10.11648/j.ajim.20210906.12},
eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.ajim.20210906.12},
abstract = {Introduction - Perioperative anaphylaxis is a hypersensitivity reaction that occurs after exposure to drugs used for anaesthesia during a surgical procedure. The most common triggers are neuromuscular blocking agents and antibiotics. Case report - A 71-old man, with a history of anaphylaxis during previous anaesthesia, was scheduled for elective coronary surgery. The clinical signs included skin rash, swelling of the upper part of the body with angioedema of the eyelids and lips, without bronchospasm. Based on the assumption that rocuronium was the most likely causative agent, percutaneous coronary intervention was performed during the same hospitalization. After recovery, he was sent for a prick skin test and intradermal test, where sensitivity to rocuronium and insensitivity to the anaesthetics used were determined. Two months later, he developed an acute myocardial infarction. Chronic total occlusive percutaneous coronary intervention was attempted, but without optimal results, so the patient was prepared for elective surgery. Due to potential further complications during anaesthesia, the medical team decided to send him for a skin allergy test for neuromuscular blocking agents. The only neuromuscular relaxant available was Cisatracurium, and it was tested for sensitivity by intradermal test. The intradermal test showed insensitivity to Cisatracurium and Suxamethonium chloride. Conclusion - Early recognition and management of anaphylaxis is based on clinical presentation. The diagnosis by in-vivo and in-vitro tests is useful to determine the cause of anaphylactic reaction and safe alternatives for future anaesthesia.},
year = {2021}
}
TY - JOUR T1 - Diagnosis and Management of Rocuronium-induced Perioperative Anaphylaxis AU - Ivana Stojanovic AU - Jelena Vuckovic AU - Matej Suntic Y1 - 2021/11/24 PY - 2021 N1 - https://doi.org/10.11648/j.ajim.20210906.12 DO - 10.11648/j.ajim.20210906.12 T2 - American Journal of Internal Medicine JF - American Journal of Internal Medicine JO - American Journal of Internal Medicine SP - 253 EP - 256 PB - Science Publishing Group SN - 2330-4324 UR - https://doi.org/10.11648/j.ajim.20210906.12 AB - Introduction - Perioperative anaphylaxis is a hypersensitivity reaction that occurs after exposure to drugs used for anaesthesia during a surgical procedure. The most common triggers are neuromuscular blocking agents and antibiotics. Case report - A 71-old man, with a history of anaphylaxis during previous anaesthesia, was scheduled for elective coronary surgery. The clinical signs included skin rash, swelling of the upper part of the body with angioedema of the eyelids and lips, without bronchospasm. Based on the assumption that rocuronium was the most likely causative agent, percutaneous coronary intervention was performed during the same hospitalization. After recovery, he was sent for a prick skin test and intradermal test, where sensitivity to rocuronium and insensitivity to the anaesthetics used were determined. Two months later, he developed an acute myocardial infarction. Chronic total occlusive percutaneous coronary intervention was attempted, but without optimal results, so the patient was prepared for elective surgery. Due to potential further complications during anaesthesia, the medical team decided to send him for a skin allergy test for neuromuscular blocking agents. The only neuromuscular relaxant available was Cisatracurium, and it was tested for sensitivity by intradermal test. The intradermal test showed insensitivity to Cisatracurium and Suxamethonium chloride. Conclusion - Early recognition and management of anaphylaxis is based on clinical presentation. The diagnosis by in-vivo and in-vitro tests is useful to determine the cause of anaphylactic reaction and safe alternatives for future anaesthesia. VL - 9 IS - 6 ER -
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