Persistent anaphylactic reaction after induction with thiopentone and cisatracurium

A 6-year-old boy presented for surgery for phimosis. The anaesthetic techni que included intravenous induction with thiopentone and neuromuscular block ade with cisatracurium. Severe persistent bronchospasm and central cyanosis followed the administration of these drugs. A continuous i.v. infusion of epinephrine at 0.2 mu g.kg(-1).min(-1) was necessary to break the severe re fractory bronchial hyperresponsiveness. There was no previous exposure to a naesthetic drugs and no definite family history of allergy. Through increas ed serum eosinophil cationic protein, tryptase and histamine levels and IgE levels specific to cisatracurium, we demonstrated an IgE-mediated anaphyla ctic reaction to cisatracurium in the child's first exposure to this new ne uromuscular blocking agent. Anaphylactic reactions to new anaesthetic drugs may be challenging to recognize and treat during general anaesthesia in ch ildren. The pathogenesis, diagnosis and management of life threatening pers istent allergic reactions to intravenous anaesthetics are discussed.