Immunoglobulin e-mediated anaphylaxis on the tenth exposure to cisatracurium in a 4-year-old child.

A 4-year-old female developed hypotension, tachycardia, hypoxemia, and diffuse erythema after induction of anesthesia with ketamine, fentanyl, and cisatracurium. Treatment consisted of repeated doses of epinephrine, diphenhydramine, corticosteroids, and IV fluids. Skin prick testing performed 4 weeks after the incident confirmed an immunoglobulin E-mediated anaphylaxis to cisatracurium. She had 8 previous exposures to cisatracurium without incident. She had experienced hypotension on the ninth exposure to cisatracurium but the decrease in arterial blood pressure was attributed to propofol. On the tenth exposure to cisatracurium, the patient developed evidence of anaphylactic shock that led to the diagnosis.