Publication: Rocuronium-Induced Anaphylactic Shock during Elective Septoplasty: A Case Report Authors
Date
2025
Journal Title
Journal ISSN
Volume Title
Publisher
Nepal APF Hospital
Abstract
Abstract:
Introduction : Perioperative anaphylaxis is a rare but potentially fatal complication during anesthesia. Among muscle relaxants, rocuronium is a leading cause of intraoperative anaphylaxis. Early recognition and prompt management are crucial to reduce morbidity and mortality.
Case presentation: We report a 14-year-old female with a medical history of Hashimoto’s thyroiditis and dissociative disorder scheduled for elective septoplasty. Following induction with midazolam, fentanyl, propofol, rocuronium, and tracheal intubation, the patient developed severe hypotension, tachycardia, generalized rash, lip swelling, and increased airway pressure, suggestive of Grade III anaphylaxis suspected to be secondary to rocuronium. Immediate management with intravenous epinephrine boluses (300 mcg ×2), fluid resuscitation (2 Litres Normal Saline), hydrocortisone, ketamine, and initiation of an epinephrine infusion (0.1 mcg/kg/min) was done and surgery was postponed. The patient was transferred to the ICU for close monitoring. Epinephrine infusion was tapered off and trachea was extubated the next day, and discharged to the ward on the third day without neurological or respiratory sequelae.
Conclusion: This case emphasizes on the importance of early recognition of rocuronium-induced anaphylaxis, rapid administration of epinephrine and aggressive supportive care. The incidence of such reactions remains low, but the high fatality rate necessitates preparedness during anesthesia.
Description
Nitendra Raj Bajracharya
Department of Anesthesiology, Nepal Armed Police Force Hospital, Balambu, Kathmandu, Nepal.
Author
https://orcid.org/0009-0006-2446-0492
Saurav Shrestha
Department of Anesthesiology, Nepal Armed Police Force Hospital, Balambu, Kathmandu, Nepal.
Author
https://orcid.org/0000-0002-1825-0097
Shova Dangol
Department of Anesthesiology, Nepal Armed Police Force Hospital, Balambu, Kathmandu, Nepal.
Author
https://orcid.org/0009-0004-6574-3531
Rabi Paudel
Department of Anesthesiology, Nepal Armed Police Force Hospital, Balambu, Kathmandu, Nepal.
Author
https://orcid.org/0009-0005-3580-4708
Pushkar Bishwokarma
Department of Anesthesiology, Nepal Armed Police Force Hospital, Balambu, Kathmandu, Nepal.
Author
https://orcid.org/0009-0008-0288-9241
Surendra Man Shrestha
Department of Anesthesiology, Nepal Armed Police Force Hospital, Balambu, Kathmandu, Nepal.
Author
https://orcid.org/0009-0006-0117-0281
Keywords
anaphylaxis, neuromuscular blocking agent, perioperative complication, resuscitation, rocuronium