Perioperative Anaphylactic Shock Induced by Cisatracurium: A Case Demonstrating the Diagnostic and Clinical Value of Early Skin Testing.

BACKGROUND Perioperative anaphylaxis is a life-threatening anesthetic emergency most commonly triggered by neuromuscular blocking agents (NMBAs). Although international guidelines recommend performing skin testing 4 to 6 weeks after the event, this delay is often impractical for patients requiring semi-urgent surgery. Delaying surgery can risk disease progression, while unguided re-exposure poses life-threatening allergic recurrence. This case report illustrates the diagnostic utility and clinical relevance of early skin testing in guiding anesthetic management when timely reoperation is necessary. CASE REPORT A 36-year-old man scheduled for laparoscopic resection of a splenic lesion experienced immediate cardiovascular collapse following administration of cisatracurium (15 mg) during anesthesia induction. He developed profound hypotension (62/34 mm Hg), tachycardia (139 bpm), and a diffuse erythematous maculopapular rash over the chest. Rapid intravenous epinephrine administration led to prompt hemodynamic stabilization. Considering the need for timely surgical completion, skin prick testing was conducted on postoperative day 6, which revealed a positive reaction to cisatracurium and a negative response to rocuronium, indicating absence of cross-reactivity. Rocuronium was subsequently used for reinduction on postoperative day 7, allowing successful completion of surgery without further adverse reactions. CONCLUSIONS This case report shows that early skin testing following perioperative anaphylaxis can be both feasible and clinically informative in urgent surgical settings. It offers a time-efficient diagnostic solution to balance safety and surgical urgency in high-risk patients. Prompt identification of the causative NMBA enables safe substitution, minimizes surgical delay, and facilitates evidence-based anesthetic management decisions.