Abstract
Anaphylaxis in the
operating room although infrequent can be potentially fatal.1 The
diagnosis of perioperative
anaphylaxis is complex due to a multitude of factors. Firstly,
patients under
anesthesia cannot verbalize their complaints, the
anesthetic agents themselves can alter vital
parameters (e.g.
heart rate and
blood pressure) and cutaneous signs in a completely draped
patient may be missed.2 Secondly, the
differential diagnosis of intraoperative
anaphylaxis is wide. Conditions such as
asthma exacerbation,
arrhythmia,
hemorrhage,
angioedema,
mastocytosis, acute
myocardial infarction,
drug overdose,
pericardial tamponade,
pulmonary edema, pulmonary
embolus,
sepsis,
tension pneumothorax, vasovagal reaction, venous
air embolism,
laryngospasm,
blood transfusion reaction and
malignant hyperthermia need to be considered.3 Thirdly, the diagnostic workup is challenging due to the multiple medications administered and other exposures encountered such as
latex and chlorhexidene. However, through a timely
allergy consultation and a systematic approach, identification of the culprit agent and safe alternatives can be established to prevent
future occurrences as illustrated in the case below.