[Anaphylactic shock lasting 4 days].

Area of Science:

• Anesthesiology
• Surgical Critical Care
• Immunology

Background:

• Intraoperative anaphylaxis is a rare but life-threatening complication during surgical procedures.
• Radical cystectomy involves significant physiological stress and potential for diverse adverse events.

Observation:

• A 62-year-old male undergoing radical cystectomy developed sudden hypotension, tachycardia, and increased airway pressure.
• Initial response to vasoactive drugs (ephedrine, phenylephrine, dopamine, norepinephrine) was absent.
• Symptoms were highly suggestive of a severe anaphylactic reaction.

Findings:

• Intravenous adrenaline administration rapidly stabilized the patient's hemodynamics and airway pressures.
• The patient required intensive care unit admission for four days, including mechanical ventilation and an adrenaline infusion.
• Diagnosis of anaphylaxis was confirmed as the cause of the intraoperative crisis.

Implications:

• This case underscores the importance of considering anaphylaxis in intraoperative hypotensive emergencies unresponsive to conventional treatment.
• Adrenaline is the first-line treatment for anaphylaxis, even in the operating room.
• Effective management requires a multidisciplinary approach involving surgeons, anesthesiologists, and critical care teams.