06 August 2026
: Case report 
Perioperative Anaphylactic Shock Induced by Cisatracurium: A Case Demonstrating the Diagnostic and Clinical Value of Early Skin Testing
Unusual clinical course, Challenging differential diagnosis, Unusual or unexpected effect of treatment, Diagnostic / therapeutic accidents, Unexpected drug reaction, Clinical situation which can not be reproduced for ethical reasons
Yu Ying ABCEF 1, Shenglan Tian ABCDEFG 2, Jingli Chen CD 3, Keding Wang DF 4, Shenghua Li ACDEF 3*DOI: 10.12659/AJCR.952854
Am J Case Rep 2026; 27:e952854
Table 1 Timeline of management and vital signs during the anaphylactic shock episode.
| Time | Intervention/management | Vital signs |
|---|---|---|
| Patient entered operating room; oxygen administration, ECG, noninvasive blood pressure (NBP), heart rate (HR), pulse oximetry, and respiratory rate (RR) monitoring initiated | NBP 131/86 mm Hg; HR 93 bpm; SpO 98%; RR 14 bpm | |
| Radial arterial catheterization for invasive blood pressure (IBP) monitoring | IBP 137/79 mm Hg; HR 95 bpm; SpO 99%; RR 14 bpm | |
| Induction of anesthesia: dexamethasone 8 mg, sufentanil 20 μg, remimazolam 15 mg, propofol 60 mg, cisatracurium 15 mg administered | (severe hypotension, tachycardia, skin flushing and maculopapular rash observed) | |
| Epinephrine 0.05 mg IV bolus administered | IBP 90/67 mm Hg; HR 115 bpm; SpO 97%; RR 19 bpm (partial hemodynamic improvement) | |
| Second epinephrine 0.05 mg IV bolus administered | IBP 140/75 mm Hg; HR 101 bpm; SpO 99%; RR 16 bpm (vital signs stabilized) | |
| Continuous norepinephrine infusion initiated at 0.05 μg/kg·min | IBP 137/89 mm Hg; HR 97 bpm; SpO 99%; RR 16 bpm (circulation maintained) | |
| Patient transferred to intensive care unit (ICU) for observation | IBP 142/93 mm Hg; HR 90 bpm; SpO 99%; RR 16 bpm (stable condition) | |
| Note: Severe anaphylactic shock occurred immediately after cisatracurium administration during induction. Prompt epinephrine boluses and continuous norepinephrine infusion rapidly restored and maintained hemodynamic stability. | ||