Keimyung Med J.  2014 Dec;33(2):140-145. 10.0000/kmj.2014.33.2.140.

Anaphylactic Shock Following Intravenous Injection of Cisatracurium and Sufentanil During Anesthesia Induction

• Kim HJ
• Bae JH
• Kwak KH

• KMID: 1967202
• DOI: http://doi.org/10.0000/kmj.2014.33.2.140

Abstract

Anaphylaxis under general anesthesia is rare but can present as cardiovascular collapse, airway obstruction, and/or skin manifestation. A high level of suspicion is required for the recognition and prompt management and anaphylaxis can be diagnosed through clinical findings. The most common causes of anaphylaxis during general anesthesia are neuromuscular blocking agents, antibiotics, and latex. We present a case of anaphylactic shock following intravenous injection of cisatracurium and sufentanil. The patient was under anesthesia induction and within minutes after injection of these drugs, generalized erythema, bronchospasm, and severe hypotension developed. The Patient was managed with epinephrine, proper hydration, hydrocortisone, and pheniramine and the surgery was decided to be postponed. Subsequent surgery should be performed after conducting skin tests which can help identify the causal agents and determine alternative drugs. Anesthesiologists should be aware that not only expeditious diagnosis and management of anaphylaxis but also further evaluation in order to determine the safe method of subsequent anesthesia.

Keyword

Anaphylaxis; Anesthesia; Cisatracurium; Shock; Sufentanil

MeSH Terms

Airway Obstruction
Anaphylaxis*
Anesthesia*
Anesthesia, General
Anti-Bacterial Agents
Bronchial Spasm
Diagnosis
Epinephrine
Erythema
Humans
Hydrocortisone
Hypotension
Injections, Intravenous*
Latex
Neuromuscular Blocking Agents
Pheniramine
Shock
Skin Manifestations
Skin Tests
Sufentanil*
Anti-Bacterial Agents
Epinephrine
Hydrocortisone
Latex
Neuromuscular Blocking Agents
Pheniramine
Sufentanil