2026 年 73 巻 3.4 号 p. 548-551
A 52-year-old woman underwent bilateral mandibular wisdom tooth extraction under general anesthesia. Immediately after the intravenous administration of cefmetazole following anesthetic induction, she developed sudden hypotension, increased airway pressure, and decreased oxygen saturation. No cutaneous manifestations were initially observed, and hypotension was refractory to vasopressor therapy. Since anaphylactic shock was suspected, surgical drapes were removed, revealing generalized erythema. Intravenous adrenaline was promptly administered, which rapidly stabilized hemodynamics and the respiratory status. She was admitted to the intensive care unit for monitoring due to the risk of a biphasic reaction ; however, there was no recurrence and she was discharged on postoperative day two. Measurements of histamine and tryptase immediately after onset and 24 hours later confirmed anaphylactic shock. Subsequent prick and intradermal skin tests identified cefmetazole as the causative agent. Although anaphylactic shock due to cefmetazole is rare, this case highlights the potential of refractory hypotension as the initial manifestation even in the absence of skin symptoms. Under general anesthesia, skin findings may be concealed, potentially delaying a diagnosis. Therefore, anesthesiologists need to maintain a high index of suspicion for anaphylaxis in patients presenting with vasopressor-refractory shock following drug administration, regardless of cutaneous signs, and initiate prompt treatment with adrenaline. J. Med. Invest. 73 : 548-551, August, 2026
