A case of pediatric perioperative anaphylaxis to neuromuscular agents and its management

Abstract

Background Perioperative anaphylaxis is one of the most challenging complications in anesthesiology. The key role is to determine the causative agent of the reaction. Neuromuscular agents are ones of the most common causes of anaphylaxis. Skin tests including prick and intradermal reaction tests are gold standard for definite diagnosis. Case presentation: We present a case of a child undergone several operations due to congenital esophageal atresia. Later on, attempts to perform a definitive repair failed because of perioperative anaphylaxis. Allergic skin tests were performed and rocuronium was found to be positive and atracurium – negative. The operation was successfully performed with atracurium. Conclusion: In patients who have gone through multiple surgeries the risk of anaphylaxis development is higher. The most common cause is considered to be neuromuscular blocking agents. In our case, after thorough examination of the anesthesiology cards, rocuronium and pipecuronium were defined as causes of anaphylaxis in our patient, so the surgery was done with atracurium which had been seen negative on a skin prick test. Eventually, the surgical procedure was performed successfully.