Anaphylaxis after general anesthesia: A pediatric case report

Abstract

Anaphylaxis is a serious systemic hypersensitivity reaction encountered across various domains of clinical practice. We report a case of anaphylaxis after general anesthesia administered for surgery.

A 9-year-old boy with a history of food allergies to kiwi, almonds, and peanuts but without any drug allergy was diagnosed with otitis media with effusion. He underwent ventilation tube insertion under general anesthesia; non-latex gloves were used during the procedure. Following induction using sevoflurane, fentanyl, and rocuronium, endotracheal intubation was performed, and sevoflurane and remifentanil were used to maintain anesthesia. Acetaminophen was administered 20 min before completion of the surgery. Fentanyl was administered after completion of the procedure, and the patient received sugammadex 13 min postoperatively. He developed a mild, dry cough 3 min after extubation; however, his vital signs were stable, and the patient was transferred to the ward. However, the dry cough persisted, and he developed mild wheezing and a pruritic rash on his body, which led to diagnosis of anaphylaxis (Grade 2 severity). The rash rapidly disappeared following administration of adrenaline and other drugs, and the patient was discharged the following morning.

Blood tests performed after discharge confirmed diagnosis of latex allergy, and a basophil activation test confirmed the diagnosis of sugammadex allergy. Although the patient underwent surgery only after following precautions with regard to his known food and latex allergies, anticipation of sugammadex-induced anaphylaxis is difficult. Removal of all allergens preoperatively and diagnosis of possible triggering agents based on methods tailored to the patient are important.