[Anaphylactic shock during elective cesarean section. Sensitizing mechanisms and follow-up]

Anaphylactic reactions during anaesthesia are increasing. Women experience these reactions more often than men. In about 50% of the cases the reaction is due to a muscle relaxant drug. Recently, Australian and French researchers have described these reactions as possibly mediated by IgE in most of the patients. As regards Ig-antibody binding, the quaternary ammonium ions seem to be potential determinants in the muscle relaxant molecule. Patients may have been sensitized by exposure to cosmetics, disinfectants or solvents, and cross-reactivity between different neuromuscular blocking agents has been described earlier. We refer to a patient who experienced an anaphylactic shock during anaesthesia by suxamethonium. She was successfully treated with epinephrine, crystalloids and mechanical ventilation. We discuss peroperative treatment, further investigation, and management at later anaesthesiological procedures.