Abstract
Neuromuscular blockers are the commonest cause of anaphylaxis in perioperative settings. The pathological process involves IgE-mediated hypersensitivity reaction with release of vasoactive inflammatory substances in response to exposure to the causative agent. Here, we present a case of atracurium-induced anaphylaxis in a patient scheduled for open cholecystectomy. The patient was treated with epinephrine. The surgery was done after a gap of 1 month post recovery. This time induction was done with vecuronium and the surgery was completed uneventfully.
Keywords: anaphylaxis; atracurium; epinephrine; general anaesthesia; IgE hypersensitivity; muscle relaxant.
References
- Portier MM, Richet C. De I’action anaphylactique de certains venims. C R Soc Biol. 1902;54:170-2.
- Levy JH, Yegin A. Anaphylaxis: What is monitored to make a diagnosis? How is therapy monitored? Anesthesiol Clin North Am.2001;19:705-15.
- Angela W Tang. A practical guide to anaphylaxis. Am Fam Physician. 2004;69(5):1049
- Vervloet D, Magnan A, Birnbaum J, Pradal M.Allergic emergencies seen in surgical suites. Clin Rev Allergy Immunol. 1999;17:459-67.
- Lieberman P. Anaphylactic reactions during surgical and medical procedures. J Allergy Clin Immunol. 2002;110:S64-9.
- Kraft S, Kinet JP. New developments in FcepsilonRI regulation, function and inhibition. Nat Rev Immunol.2007;7:365-78.
- Liberman P, Nicklas RA, Oppenheimer J, et al. The diagnosis and management of anaphylaxis practice parameter: 2010 update. J Allergy Clin Immunol 2010;126(6):1104.
- Ebo DG, Fisher MM, Hagendorens MM, Bridts CH, Stevens WJ. Anaphylaxis during anaesthesia:diagnostic approach. Allergy. 2007;62:471-87.
Corresponding Author
Dr Ritu Rani
Dermatologist, Civil Hospital Kangra, H.P., India