Penicillin-induced anaphylaxis in a patient under hypotensive anesthesia

Elective use of penicillin during hypotensive anesthesia for orthognathic surgery induced a nearly fatal anaphylactic reaction. The first symptom of anaphylaxis was increased inspiratory resistance to mechanical ventilation, followed by severe hypotension. The therapeutic management of anaphylaxis is discussed. Patients susceptible to reactions from the administration of B-lactam antibiotics can be identified through skin tests. Patients reactive to such antibiotics should be treated with alternate antibiotics or they should be desensitized prior to receiving penicillin.