1. Helga Komen Ušljebrka, MD, anaesthesiologist
Department of Anaesthesiology and Intensive Care
University Hospital Rijeka, Croatia

2. Patient history
M.P., female, 67 years
 BMI 27.3 kg/m2
Dg: Cholelithiasis
Elective surgery: Laparoscopic cholecystectomy
Comorbidity: Hypotireosis, Hypertension,
Hyperlipoproteinemy
Th: levothyroxine 25 μg, cilazapril 2.5 mg
No previous operations (general or regional anaesthesia)
Allergy to anaesthetic agent

3. Patient history
Preoperative physical examination:
Respiratory status NA
Hemodinamical status:
 BP 140/85 mmHg
 ECG - axis 15o , sinus rhytm 78/min
Laboratory findings:
 Thyroid hormons – T3 2.11 nmol/L, T4 170.62 nmol/L, TSH
1.65 mIU/L (within range)
 Full blood count , biochemical analysis – NA
Allergies: Ǿ
Allergy to anaesthetic agent

4. Preoperatively...
enoxaparin 40 mg sc, 21.00h evening before surgery
midazolam 7.5 mg orally, 1 h preoperatively (9.30 AM)
BP 155/85 mmHg
HR 90/min
Allergy to anaesthetic agent

5. Intraoperatively...
Standard monitoring – ECG, SpO2, NIBP
iv line 18 G, left hand
Induction of anaesthesia (10.40 AM):
 sufentanil 30 μg iv
 thiopental 350 mg iv
 rocuronium 40 mg iv
→ Rash
→ Orotracheal intubation (10.43 AM)
Allergy to anaesthetic agent

6. Intraoperatively...
.......deep hypotension – 45/20 mmHg
.......difficult ventilation – peak airway pressure 32 cmH20,
SpO2 91 %, FiO2 100%
→ Asistoly
→ CPR according to ALS algorythm
+ fluid resuscitation, antihistaminic, steroid
After 45 minutes....ROSC!
Allergy to anaesthetic agent

7. ICU
• Cancelled surgery → ICU admission
•Vasoactive drugs – excluded POD 2
Respiratory support – weaning and extubation POD 9
POD 1, MSCT of the brain: normal finding
POD 3, MSCT of the brain: ischemia cortically and
subcortically in the right hemisphere
Neurological status (POD 7): left hemiplegia with tendency of
recovery......
Discharge POD 19 – paresis of left hand, patient in contact
Allergy to anaesthetic agent

8. Allergy testing (3 months later)
Skin test
midazolam, propofol, thiopental, sufentanil, soya –
NEGATIVE
Rocuornium - POSITIVE
Allergy to anaesthetic agent

9. Questions to be answered!
Incidence of allergy to muscle relaxants/anaesthetics?
How to predict it?
In case of, what is the alternative?
Allergy to anaesthetic agent

10. Statistics....
Anaphylaxis in anaesthesia 1/10 000 – 1/ 20 000
Grade I - V
Pseudoanaphylaxis – chemically mediated
histamine release
50% on NMBAs (leptosucyn, rocuronium)
Cross-alergy
! Folcodine
Allergy on food no important
Allergy to anaesthetic agent

11. THANK YOU!
Allergy to anaesthetic agent