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.