Anaesthetic allergy: Overview

Abstract
Background: Malignant hyperthermia (MH) is a rare but life-threatening complication of general anesthesia, characterized by a hypermetabolic response that can lead to severe complications if not managed promptly. Patients with neuromuscular disorders, such as cerebral palsy and neuromuscular scoliosis, may have an increased risk of developing MH due to underlying genetic and physiological factors. Despite its rarity, early recognition and intervention are critical for patient survival.

Case presentation: We present a case of MH in a 13-year-old girl with cerebral palsy and neuromuscular scoliosis undergoing elective scoliosis correction surgery under general anesthesia. The patient had no prior history of mental health (MH) susceptibility or a family history of the condition. After 90 min of surgery, she exhibited a rapid increase in end-tidal carbon dioxide (EtCO₂) to 60 mmHg, tachycardia (190 bpm), hypotension (70/40 mmHg), hyperthermia (41°C), and muscle rigidity, raising suspicion of MH. Sevoflurane inhalation was immediately discontinued, and the anesthesia circuit was changed to allow pure oxygen inhalation. The patient was treated with intravenous dantrolene, active cooling measures, forced alkaline diuresis, and correction of acid-base disturbances. These interventions successfully stabilized her vital signs, allowing the surgery to proceed safely. Postoperatively, she was transferred to the intensive care unit (ICU) for monitoring and was extubated once her condition stabilized. She was discharged on postoperative day 7 without further complications.

Conclusion: This case highlights the critical need for anesthesiologists and surgical teams to remain vigilant for MH in patients with neuromuscular disorders, even in the absence of a family history. Prompt recognition and immediate intervention with dantrolene and supportive therapies are essential for a favorable outcome. Preoperative MH risk assessment, avoidance of trigg

Abstract
We describe the case of a 55-year-old woman proposed for an elective unilateral mastectomy with sentinel node biopsy due to breast cancer. The patient has a history of four episodes of anaphylaxis, one of which occurred during the induction of general anesthesia and resulted in cardiorespiratory arrest, which was reversed with advanced life support. The intradermal tests confirmed allergy to propofol, all types of neuromuscular relaxants, ketorolac, acetylsalicylic acid, generic antibiotics, and iodinated contrast agents. Following a multidisciplinary discussion that included anesthesiology, gynecology, allergy and clinical immunology, and the patient, it was decided to perform a thoracic epidural block in combination with interpectoral and pectoserratus plane blocks for the surgery. The patient requested anxiolysis via music therapy. The procedure was uneventful, and the patient was transferred to the post-anesthetic care unit, where she remained under vigilance for 12 hours.

Abstract
A 13-year-old otherwise healthy girl underwent general anesthesia for the first time in her life for an elective surgery to treat a meniscus injury. During surgery, she experienced anaphylactic shock and the surgery was immediately terminated. Subsequent allergy screening for rocuronium, chlorhexidine, povidone-iodine, and latex yielded all negative results. She was referred to our hospital for diagnosis of a causal agent. A challenge test was performed in the operating room for the following 5 drugs: fentanyl, sevoflurane, rocuronium, propofol, and remifentanil. Anaphylactic symptoms occurred with only sevoflurane. This is the first report of a confirmed sevoflurane allergy.