[Anaphylaxis by atracurium. One case report]

Area of Science:

• Anesthesiology
• Immunology
• Pharmacology

Background:

• Severe intraoperative anesthetic reactions occur infrequently, with reported incidences ranging from 1:10,000 to 1:13,000 surgeries.
• Patients undergoing general anesthesia are at risk for adverse reactions, necessitating thorough pre-operative assessment.

Observation:

• A 13-year-old male with a history of atopy and allergies experienced a severe anaphylactoid reaction during anesthesia induction with atracurium.
• The reaction, characterized by rash, edema, bronchoconstriction, and hypotension, initially did not respond to standard treatments but subsided with antihistamines and epinephrine.
• While skin prick tests for atracurium were negative, intradermal testing revealed a positive response, suggesting a possible hypersensitivity.

Findings:

• Atracurium is a known histamine releaser, capable of causing non-immunological mast cell activation.
• The significant skin response observed in this case raises the possibility of a rare IgE-mediated hypersensitivity reaction to atracurium.
• Diagnostic challenges exist in differentiating non-immunological histamine release from true allergic reactions to neuromuscular blocking agents.

Implications:

• This case underscores the importance of considering rare IgE-mediated reactions to neuromuscular blocking agents like atracurium, even with negative initial allergy tests.
• Further investigation into diagnostic methods for distinguishing between histamine release and IgE-mediated reactions to atracurium is warranted.
• Anesthesiologists should maintain a high index of suspicion for hypersensitivity reactions and be prepared for prompt management.