2000 Volume 19 Issue 1 Pages 52-55
A 60-yr-old man with Chiari malformation was scheduled for occipital decompression. After uneventful anesthetic induction with thiopental and vecuronium, anesthesia was maintained with nitrous oxide and isoflurane. Seventeen minutes after tracheal intubation, cardiovascular collapse (systolic blood pressure was 37 mmHg) developed with a generalized cutaneous rash, but without bronchospasm. Resuscitative treatments including rapid infusion of Ringer's solution of 2, 000 ml and administration of epinephrine and methylprednisolone improved hemodynamic status and cutaneous rash disappeared after 30 min. The operation was postponed. A diagnosis of anaphylactoid shock was obtained from blood tests of immunological markers. Intradermal tests performed on the next day were negative for all of the drugs administered. However, the examination repeated 6 weeks later revealed positive reactions to vecuronium and pancuronium. Anesthesia for the decompression surgery was performed uneventfully without using nondepolarizing neuromuscular blockers three months later. Because of low predictive value of skin tests examined in acute phase, such a test is recommended to be carried out more than 4 to 6 weeks after the allergic event.
