We reported that anaphylactic shock was caused by administering intravenously rocuronium during general anesthesia. A 42-year-old female (height 156 cm, weight 48kg) patient, diagnosed with a jaw deformity, was scheduled for the sagittal splitting method of the mandibular ramus under general anesthesia. She was diagnosed with asymptomatic primary biliary cirrhosis at 38 years old and took ursodeoxycholic acid medicine orally. Anesthesia was induced with intravenous fentanyl 50μg, propofol 100mg, remifentanyl 0.1γ c.i.v. and rocuronium 40 mg and maintained with Air, O_2 and sevoflurane. About 10 min after tracheal intubation, the patient developed a skin rash, hypotension (56/30 mmHg) and sinus bradycardia (50 bpm) and was treated with successive administration of adrenaline 0.3 mg i.m., hydrocortisone sodium succinate 500mg, polaramin 5 mg i.v. and was given infusion rapidly from two places of peripheral intravenous lines in accordance with the anaphylactic guidelines. Fortunately, the patient recovered without serious symptoms. The subsequent skin test results led to a diagnosis of rocuronium-induced anaphylaxis. Anaphylaxis is a systemic allergic reaction. Therefore, it is important for not only to begin treatment at the time of onset but also to diagnose serologically and identify the responsible agent with skin testing. When anaphylaxis happens, we must act quickly according to in-hospital guidelines so that symptoms do not make it serious. Moreover, we must fix the cooperation system between medical doctors and nurse.
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