Bronchospasm Induced by Propofol in a Patient with Sick House Syndrome

decreased to 88%–92%. There were no signs of anaphylactoid reaction such as hypotension or skin erythema. Methylprednisolone 125 mg and aminophylline 250 mg were administered IV. One hour later, expiratory wheezes had disappeared gradually, and Spo2 had increased to 98%. Anesthesia was maintained with 0.5%–1.0% sevoflurane. During this time, surgery was terminated. Surgery was rescheduled 2 wk later. Anesthesia was induced with midazolam 4 mg and sevoflurane 2%– 4%. A laryngeal mask was inserted without difficulty. Anesthesia was maintained with 2 L/min of nitrous oxide, 1 L/min of oxygen, and 1.5%–2.5% sevoflurane. There were no signs of bronchospasm during the surgery, although she had sudden intermittent attacks of severe headaches after surgery, and a magnetic resonance imaging angiograph revealed two unruptured brain aneurysms. Four weeks after the operation, the patient underwent interdermal skin tests. The dermal skin tests showed negative reactions for propofol, vecuronium, and other drugs. Drug lymphocyte stimulation tests (DLSTs) showed a positive reaction for propofol (Diprivan ® ) but a negative reaction for Intralipid ® and other drugs (Table 1). At 8 wk after the operation, she was scheduled for a craniotomy. Anesthesia was induced with midazolam, vecuronium, and sevoflurane and maintained with 4 L/min of nitrous oxide, 2 L/min of oxygen, 1.5%–2.5% sevoflurane, and 700 g of fentanyl. There were no signs of bronchospasm, and she was discharged on postoperative Day 20.