A Case Report of Intraoperative Shock Following Spinal Anesthesia: Could It Be All of the Above?

Perioperative cardiovascular collapse may result from several life-threatening conditions with overlapping clinical manifestations, making the diagnosis challenging.We present a case of a 37-year-old man with morbid obesity who underwent fixation of a tibial plateau fracture.Following an uneventful ultrasoundguided femoral nerve block and spinal anesthesia, intravenous cefazolin was administered.Within minutes, the patient developed lightheadedness, nausea, loss of consciousness, jaw rigidity, and severe hypotension, refractory to fluid administration and vasopressor boluses, followed by bradycardia and respiratory distress.Point-of-care echocardiography showed preserved biventricular function and findings suggestive of marked hypovolemia, without right ventricular dysfunction.One hour after hemodynamic stabilization, the patient developed a maculopapular rash.Serial serum tryptase concentrations were markedly elevated, supporting the diagnosis of perioperative anaphylaxis.The patient recovered uneventfully and was referred to an allergy and immunology specialist.This case highlights the complexity of diagnosing sudden cardiovascular collapse during neuraxial anesthesia when several potentially life-threatening conditions are considered.Perioperative anaphylaxis should always be considered in cases of unexplained severe hypotension, even in the absence of bronchospasm or cutaneous manifestations.