Severe Anaphylaxis without Key Signs Such as Urticaria and Bronchospasm Suspected to Be Induced by Rocuronium

Abstract

Perioperative hypersensitivity reaction have been reported to have a variable degree of the incidence from differ countries and to be 1/353–18,600 approximately and its mortality has been reported to be 4%–4.76% in the United States and Japan, respectively. A 65-year-old male patient with hypertension, rheumatoid arthritis, and history of amoxicillin allergy was scheduled for laparoscopic radical prostatectomy due to prostate cancer. Lidocaine, propofol, and rocuronium were administered sequentially to induce general anesthesia. Twenty minutes after the rocuronium administration, severe hypotension and tachycardia developed. But key signs of hypersensitivity such as urticaria and bronchospasm were not appeared. The operation was canceled and we evaluated the cause of severe hypotension and could confirm hypersensitivity for rocuronium with intradermal test after 4 weeks. Key words: Anaphylaxis; Intradermal tests; Rocuronium; Urticaria