A Case of Anaphylactic Shock Diagnosed on Second Implementation of Anesthetic Management

Abstract

An 80-year-old woman underwent emergency craniotomy and aneurysmal neck clipping for subarachnoid hemorrhage. Although serious hypotension occurred after induction of general anesthesia, surgery proceeded with a diagnosis of hypovolemic shock. Approximately two months later, ventriculoperitoneal shunt placement was scheduled for hydrocephalus following subarachnoid hemorrhage. After induction of general anesthesia, the patient developed serious hypotension accompanied with generalized redness. Anaphylactic shock was diagnosed and surgery was canceled. Serum tryptase and histamine was elevated, and skin prick test was positive for rocuronium. Even during emergency operation, when we encounter a patient with hypotension unresponsive to normal dose of vasopressors, we always consider the possibility of anaphylaxis without skin redness.