Rocuronium anaphylaxis in a 7-year-old boy during the induction of anesthesia

Figures & data

Figure 1. Clinical course. The first symptoms of bronchospasm arose at 11 min after venous injection of propofol and rocuronium, followed by cefazolin sodium 4 min later. After the administration of inhaled β2-stimulant, adrenaline, ephedrine hydrochloride, methylprednisolone, and hydroxyzine, bronchospasm disappeared and vital signs became stable.

Table 1. Skin tests.

	Scratch test	Intradermal test
Normal saline: negative control	Stock solution	Stock solution
Flare	1 × 1	1 × 1	NT	NT
Rocuronium Br dilution (concentration)	Stock solution (10 mg/mL)	1:1000 (10 μg/mL)	1:500 (20 μg/mL)	1:200 (50 μg/mL)
Flare wheal	14 × 11^a swelling little	1 × 1 1 × 1	14 × 13^a 8 × 8	NT
Propofol dilution (concentration)	Stock solution (10 mg/mL)	1:1000 (10 g/mL)	1:100 (100 μg/mL)	1:10 (l mg/mL)
Flare	1 × 1	1 × 1	1 × 1	1 × 1
Cefazolin Na dilution (concentration)	Stock solution (l mg/mL)	1:100 (0.01 mg/mL)	1:10 (0.l mg/mL)	Stock solution (l mg/mL)
Flare	1 × 1	1 × 1	1 × 1	1 × 1
Histamine: positive control (concentration)	Stock solution (10 mg/mL)	Stock solution (10 mg/mL)
Flare wheal	14 × 14 8 × 8	NT	14 × 15 8 × 8	NT

Flare and wheal: long diameter × short diameter (mm); NT: not tested. Normal saline and histamine at 10 mg/mL were used as negative and positive controls, respectively. Since, the patient was too young to be taken multiple needle-prick, negative and positive control tests were performed only twice. We performed scratch test, alternative of prick test, as prick needles were not available and also we were used to scratch test to various food allergens. The dose of intradermal injection, using a 26-gauge needle, was 0.03 mL. Rocuronium bromide, propofol, and cefazolin Na were diluted by 1:1000 to 1:200-fold, 1:1000 to 1:10-fold and 1:100 to 1:1-fold, respectively as recommended. Within 5 min after the injection of rocuronium diluted by 1:500-fold, the flare diameter and wheal diameter reached 14 × 13 mm and 8 × 8 mm, respectively. At 15 min following the scratch, the wheal diameter of histamine was 8 × 8 mm. Any of flare diameter of normal saline, propofol, and cefazolin Na was 1 mm.

^aIt appeared within 5 min after the start of stimulation.