title: Early skin and challenge testing after rocuronium anaphylaxis.
abstract: We present a case of early skin and challenge testing in a patient following severe anaphylaxis to rocuronium. The patient presented for semi-elective laparoscopic cholecystectomy and developed anaphylaxis with severe cardiovascular collapse after induction of anaesthesia. Surgery was cancelled but was considered necessary before the recommended four to six weeks for formal allergy testing. Limited skin and challenge testing was performed to rocuronium and cisatracurium while the patient was in the intensive care unit to identify a safe neuromuscular blocking drug for subsequent early surgery. The subsequent surgery, 48 hours after the initial reaction, was uneventful. The case highlights the difficulties when anaesthetising patients with recent anaphylaxis who have not yet had formal allergy testing and presents a potential management strategy involving early skin testing.
authors.affiliation: Anaesthetic Registrar, Department of Anaesthesia, Peninsula Health, Frankston, Victoria.
authors.forename: E M
authors.initials: EM
authors.lastname: Schulberg
authors.affiliation: Specialist Anaesthetist, Department of Anaesthesia, Peninsula Health, Frankston, Victoria.
authors.forename: A R
authors.initials: AR
authors.lastname: Webb
authors.affiliation: Specialist Anaesthetist, Department of Anaesthesia, Peninsula Health, Frankston, Victoria.
authors.forename: H
authors.initials: H
authors.lastname: Kolawole
mesh_terms: D000293:Adolescent; D000707:Anaphylaxis / Q000139:chemically induced* / Q000175:diagnosis / Q000276:immunology; D000732:Androstanols / Q000009:adverse effects* / Q000276:immunology; D001279:Atracurium / Q000009:adverse effects / Q000031:analogs & derivatives / Q000276:immunology; D017081:Cholecystectomy, Laparoscopic / Q000379:methods; D005260:Female; D006801:Humans; D003473:Neuromuscular Nondepolarizing Agents / Q000009:adverse effects* / Q000276:immunology; D000077123:Rocuronium; D012882:Skin Tests
chemical_list: D000732:Androstanols; D003473:Neuromuscular Nondepolarizing Agents; D001279:Atracurium; C101584:cisatracurium; D000077123:Rocuronium
keywords: anaesthesia; anaphylaxis; neuromuscular blocking agents; remifentanil; rocuronium