Case report: treatment of rocuronium-induced anaphylactic shock with vasopressin

To report the use of vasopressin to treat a patient who, after failing to respond to volume expansion and epinephrine administration, experienced an anaphylactic reaction to rocuronium.

A 17-yr-old female was scheduled to undergo transnasal, transsphenoidal resection of a pituitary tumour. Shortly after induction of general anesthesia, for which rocuronium 50 mg iv was administered to facilitate tracheal intubation, the patient developed severe hypotension and diffuse erythema. This severe,allergic response was refractory to the administration of intravenous fluids, epinephrine, and phenylephrine. However, arginine vasopressin, administered intravenously as a bolus of two units, followed by an infusion of 2 U.hr(-1), rapidly corrected the hemodynamic instability. Her recovery from this episode was uneventful, but surgery was cancelled. Skin testing, performed six weeks later, was positive for rocuronium and negative for cisatracurium and latex, as well as all other medications administered. Eight weeks later, the surgical procedure was performed, uneventfully, using cisatracurium as the muscle relaxant.

Vasopressin may be effective in the resuscitation of anesthetized patients, with hemodynamic instability associated with anaphylaxis resistant to epinephrine and alpha-agonists.