Palonosetron-Induced Anaphylaxis During General Anesthesia: A Case Report

Anaphylactic response to drugs manifests as a respiratory distress due to laryngeal edema and intense bronchospasm, often followed by vascular collapse or shock. Several redisposing factors are associated with hypersensitivity reactions to drugs in patients. Antibiotics, anesthetics agents, non-steroidal antiinflammatory drugs, and opiates are common triggers of anaphylaxis. Severe hypersensitivity reaction during general anesthesia is one of the most frequent drug-induced anaphylactic reactions, as recently shown by several studies in the United States. Diagnosis of perioperative anaphylaxis is complicated as the patient is often sedated and thus unable to alert the physician of symptoms. Additionally, diagnosis can be hampered by obstruction of skin manifestations with surgical drapes, and cardiac events associated with anaphylaxis can be mistaken for other causes of cardiovascular collapse. Furthermore, multiple drugs are frequently administered simultaneously or in rapid succession during surgery. Most hypersensitivity reactions occur within minutes after administration of the drug; however, depending on the agent and time of administration, reactions can be lateonset. Common drugs causing anaphylaxis include neuromuscular blocking agents, latex, antibiotics, hypnotics, opioids, and colloids. Palonosetron is a 5-hydroxytryptamine3 (5-HT3) antagonist used for the prevention and treatment of nausea and vomiting due to cancer chemotherapy and surgery. Other commonly used 5-HT3 antagonists include ondansetron and granisetron (Fig. 1). Additionally, ondansetronand granisetron-related hypersensitivity reactions have been reported in 8 and 2 patients, respectively. In this report, we describe a patient who developed anaphylaxis during general anesthesia following intravenous palonosetron administration. Palonosetron-Induced Anaphylaxis During General Anesthesia: A Case Report Hyungjun Park, Kyunghwan Oh, Hoonhee Lee, Ji-Hyang Lee, Sun-myoung Kang, So-Young Park, Hyouk-Soo Kwon, You Sook Cho, Hee-Bom Moon, Tae-Bum Kim*