Rocuronium-Induced Anaphylactic Shock during Elective Septoplasty: A Case Report

Introduction : Perioperative anaphylaxis is a rare but potentially fatal complication during anesthesia. Among muscle relaxants, rocuronium is a leading cause of intraoperative anaphylaxis. Early recognition and prompt management are crucial to reduce morbidity and mortality. Case presentation: We report a 14-year-old female with a medical history of Hashimoto’s thyroiditis and dissociative disorder scheduled for elective septoplasty. Following induction with midazolam, fentanyl, propofol, rocuronium, and tracheal intubation, the patient developed severe hypotension, tachycardia, generalized rash, lip swelling, and increased airway pressure, suggestive of Grade III anaphylaxis suspected to be secondary to rocuronium. Immediate management with intravenous epinephrine boluses (300 mcg ×2), fluid resuscitation (2 Litres Normal Saline), hydrocortisone, ketamine, and initiation of an epinephrine infusion (0.1 mcg/kg/min) was done and surgery was postponed. The patient was transferred to the ICU for close monitoring. Epinephrine infusion was tapered off and trachea was extubated the next day, and discharged to the ward on the third day without neurological or respiratory sequelae. Conclusion: This case emphasizes on the importance of early recognition of rocuronium-induced anaphylaxis, rapid administration of epinephrine and aggressive supportive care. The incidence of such reactions remains low, but the high fatality rate necessitates preparedness during anesthesia.