title: Acute coronary syndrome in cisatracurium-induced anaphylactic shock: Kounis syndrome.
abstract: In this case report, we describe a 70-year-old male patient who sustained Kounis syndrome induced by cisatracurium administration immediately following induction of general anesthesia. Acute coronary syndrome combined with anaphylactic shock, termed Kounis syndrome, should be investigated in percutaneous coronary intervention to solve this complex and life-threatening condition. A team effort by cardiologist and anesthesiologist is essential for successful resuscitation. In general, the incidence of an anaphylactic reaction to cisatracurium is low, but a high serum IgE level in combination with a positive skin prick test in our patient was strongly suggestive of cisatracurium-induced Kounis syndrome. In addition, a cross-reaction between cisatracurium and rocuronium is reported.
authors.affiliation: Department of Anesthesiology, Chang Gung Memorial Hospital-Kaohsiung Medical Center and Chang Gung University College of Medicine, Kaohsiung, Taiwan, ROC.
authors.forename: Ya-Ling
authors.initials: YL
authors.lastname: Yang
authors.forename: Hui-Wen
authors.initials: HW
authors.lastname: Huang
authors.forename: Hon-Kan
authors.initials: HK
authors.lastname: Yip
authors.forename: Bruno
authors.initials: B
authors.lastname: Jawan
authors.forename: Chia-Chih
authors.initials: CC
authors.lastname: Tseng
authors.forename: Hsiao-Feng
authors.initials: HF
authors.lastname: Lu
mesh_terms: D054058:Acute Coronary Syndrome / Q000139:chemically induced*; D000368:Aged; D000707:Anaphylaxis / Q000139:chemically induced*; D001279:Atracurium / Q000009:adverse effects / Q000031:analogs & derivatives*; D006801:Humans; D008297:Male; D009466:Neuromuscular Blocking Agents / Q000009:adverse effects*; D013577:Syndrome
chemical_list: D009466:Neuromuscular Blocking Agents; D001279:Atracurium; C101584:cisatracurium