Severe Intraoperative Anaphylactic Reaction: Aprotinin and Rocuronium

摘要

ANAPHYLACTIC REACTIONS ARE life-threatening situations, with sudden onset, that can happen at any time during anesthesia. Muscle relaxants are the most frequently involved drugs, causing 60% of the intraoperative anaphylactic reactions. Other drugs, like aprotinin, have higher potential to produce an allergic reaction; however, their use is rare com-pared with the routine use of neuromuscular-blocking drugs (NMBDs).In the case reported here, a severe anaphylactic reaction occurred after a 1-mL test dose of aprotinin in an adult patient who had a previous exposure to the drug almost 1 year before. There have been other reports of anaphylaxis to aprotinin test doses, but they have occurred in early re-exposures (less than 2 months) and/or when using test doses much larger than recommended. This case suggests the need for other screening tests for anaphylaxis. The allergy workup in this patient revealed sensitization to 2 different drugs: aprotinin, as expected, and, unexpectedly, rocuronium. Therefore, this case also shows that every patient who experiences anaphylaxis must be investigated and advised on future care.