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Immunoglobulin e-mediated anaphylaxis on the tenth exposure to cisatracurium in a 4-year-old child

Robin DeCoursey Jenson1, Leigh B Latham, Girish V Vitalpur

  • 1From the Departments of *Anesthesiology and †Allergy and Immunology, Riley Hospital for Children, Indianapolis, Indiana.

A & a Case Reports
|January 23, 2015
PubMed

Insights

Anaphylaxis to cisatracurium, a neuromuscular blocker, can occur even after multiple uneventful exposures. This case highlights the potential for delayed-onset, severe allergic reactions during anesthesia.

Area of Science:

  • Anesthesiology
  • Immunology
  • Pharmacology

Background:

  • Anaphylaxis is a severe, potentially life-threatening allergic reaction.
  • Neuromuscular blocking agents are common causes of perioperative anaphylaxis.
  • Cisatracurium is a widely used non-depolarizing neuromuscular blocker.

Purpose of the Study:

  • To report a case of anaphylaxis to cisatracurium in a pediatric patient.
  • To emphasize the importance of considering drug-induced anaphylaxis in unexplained perioperative events.

Main Methods:

  • Case report of a 4-year-old female experiencing anaphylactic shock post-anesthesia.
  • Diagnostic workup included skin prick testing 4 weeks after the event.
  • Review of patient's anesthetic history and drug exposures.

Main Results:

  • The patient developed hypotension, tachycardia, hypoxemia, and erythema after anesthesia induction.
  • Skin prick testing confirmed immunoglobulin E-mediated anaphylaxis to cisatracurium.
  • The reaction occurred on the tenth exposure to cisatracurium, despite previous uneventful administrations.

Conclusions:

  • Cisatracurium can cause delayed-onset anaphylaxis, even after multiple prior exposures.
  • Anaphylaxis to neuromuscular blocking agents should be suspected in patients with unexplained hemodynamic instability during anesthesia.
  • Prompt recognition and management are crucial for favorable outcomes in anaphylactic shock.

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