Persistent anaphylactic reaction after induction with thiopentone and cisatracurium

Area of Science:

• Anesthesiology
• Pediatric Allergy
• Clinical Immunology

Background:

• Phimosis surgery in a 6-year-old boy.
• Standard anesthetic induction with thiopentone and neuromuscular blockade with cisatracurium.
• No prior exposure to anesthetic agents or known allergy history.

Observation:

• Development of severe, persistent bronchospasm and central cyanosis post-drug administration.
• Refractory bronchial hyperresponsiveness necessitating continuous epinephrine infusion.
• Absence of prior sensitization to anesthetic drugs.

Findings:

• Diagnosis of an IgE-mediated anaphylactic reaction to cisatracurium.
• Elevated serum markers: eosinophil cationic protein, tryptase, histamine, and cisatracurium-specific IgE.
• First reported case of anaphylaxis to cisatracurium in a pediatric patient.

Implications:

• Anaphylactic reactions to novel anesthetic agents can be difficult to identify during pediatric general anesthesia.
• Early recognition and prompt management are crucial for life-threatening allergic reactions.
• Understanding the pathogenesis and diagnosis of anaphylaxis to intravenous anesthetics is vital for patient safety.