Rocuronium bromide induced anaphylaxis in a child -A case report-

Area of Science:

• Anesthesiology
• Pediatric Critical Care
• Immunology

Background:

• Anaphylaxis during anesthesia in pediatric patients is an infrequent but serious adverse event.
• Identifying triggers is crucial for preventing recurrence and ensuring patient safety.

Purpose of the Study:

• To report a case of rocuronium-induced anaphylaxis in a pediatric patient undergoing surgery.
• To highlight the importance of recognizing and managing anaphylactic reactions during anesthesia.
• To demonstrate an alternative anesthetic approach following a severe adverse event.

Main Methods:

• Case report of a 33-month-old female patient.
• Administration of rocuronium during anesthesia for escharectomy.
• Monitoring of vital signs including blood pressure, heart rate, and oxygen saturation.
• Subsequent anesthetic management using volatile induction and maintenance with sevoflurane without muscle relaxants.

Main Results:

• The patient experienced severe hypotension, tachycardia, and hypoxia shortly after rocuronium administration.
• A similar anaphylactic reaction recurred upon subsequent administration of rocuronium.
• Anesthesia was successfully managed in seven subsequent operations using sevoflurane without muscle relaxants, with no adverse events.

Conclusions:

• Rocuronium can induce anaphylactic reactions in pediatric patients, even with prior uneventful exposures.
• Careful consideration of anesthetic agents is necessary in patients with a history of anaphylaxis.
• Alternative anesthetic techniques, such as volatile agents without muscle relaxants, can provide a safe option for patients with known sensitivities.