Cisatracurium besilate
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Anaphylactic reaction: case report. A 40-year-old woman experienced a severe anaphylactic reaction following administration of cisatracurium besilate for general anaesthesia. The woman, who had previously undergone appendectomy and ovarian cystectomy under general anaesthesia without complications, was hospitalised to undergo laparoscopic ovarian cystectomy. In the operation room, she received fentanyl and midazolam, followed by propofol and IV cisatracurium besilate [cisatracurium] 5mg for the induction of general anaesthesia. After 5 minutes, she received cefuroxime for infection prophylaxis. Within a few minutes of cefuroxime administration, she developed redness of the eyes and face flushing. Her BP was 39/29mm Hg, while her HR rapidly elevated to 135 bpm. An anaphylactic reaction was suspected [time to reaction onset not stated]. The woman was intubated and treated as a case of anaphylactic shock until her vital signs recovered. Following stabilisation of her vital signs, the residual neuromuscular blockade was reversed with neostigmine. The surgery was postponed. Initially, the development of anaphylaxis was believed to be due to cefuroxime. Four weeks later, skin tests for ampicillin, amoxicillin, benzyl penicillin and cefuroxime were found to be negative. Subsequently, oral provocation test with cefuroxime was also found to be negative. Therefore, she underwent tests with perioperative drugs, including fentanyl, propofol, midazolam and cisatracurium besilate. Skin prick tests with cisatracurium besilate and atracurium besilate [atracurium], performed due to known existing crossreactivity between them, were found to be positive. Hence, the anaphylactic reaction was attributed to cisatracurium besilate. Linauskiene K, et al. Severe anaphylactic reaction to cisatracurium during anesthesia with cross-reactivity to atracurium. Open Medicine 15: 384-386, No. 1, 1 Mar 2006. Available from: URL: http://doi.org/10.1515/med-2020-0126 803519514
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Reactions 5 Dec 2020 No. 1833
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