Refractory Unforeseen Anaphylaxis Case in a Rural OR Unit.

Area of Science:

• Anesthesiology
• Allergy and Immunology
• Pharmacology

Background:

• Anaphylaxis is a severe, life-threatening allergic reaction that can occur unpredictably.
• Prophylactic antibiotic administration, such as cefazolin, is common before surgical procedures.
• Patient presented with no prior documented allergies.

Observation:

• A 35-year-old female developed sudden, severe anaphylaxis with respiratory distress and cardiovascular collapse post-intravenous cefazolin.
• Initial intramuscular and intravenous epinephrine boluses were insufficient; an epinephrine infusion was required for stabilization.
• The patient was discharged the following day after medical assessment.

Findings:

• Intravenous cefazolin can precipitate rapid-onset, severe anaphylaxis, even in patients with no known allergy history.
• Anaphylaxis management in the operating room requires prompt and potentially escalating epinephrine administration.
• Standard allergy testing may not identify the causative agent in all cases of drug-induced anaphylaxis.

Implications:

• This case underscores the critical importance of immediate recognition and aggressive management of perioperative anaphylaxis.
• It highlights the potential for severe reactions to routine prophylactic antibiotics.
• The necessity of having advanced resuscitation capabilities, including epinephrine infusions, readily available in the operating theatre is emphasized.