Sevoflurane 투여 후 발생한 Anaphylaxis 유사 반응: 증례보고

Suspected anaphylactoid reaction following sevoflurane administration: a case report

This case report details a presumed anaphylactoid reaction in a 53-year-old female with a known remifentanil allergy, where sevoflurane was identified as the probable causative agent based on strong clinical evidence. The patient was scheduled for a repeat thyroid radiofrequency ablation under general anesthesia. Anesthesia was induced with propofol and maintained with sevoflurane and nitrous oxide, deliberately avoiding remifentanil. Despite stable initial vital signs, the patient developed sudden, severe hypotension (73/46 mmHg) and tachycardia (121 bpm) approximately five minutes after the introduction of sevoflurane. The clinical presentation, characterized exclusively by cardiovascular collapse without cutaneous or respiratory signs, was consistent with a grade 2 anaphylactic reaction. Definitive laboratory tests, such as serum tryptase and basophil activation tests (BAT), were not performed. Therefore, the diagnosis was established based on the clinical context: a clear temporal relationship between the administration of sevoflurane and the onset of symptoms, combined with the exclusion of other potential causes. Immediate fluid resuscitation and vasopressor support, culminating in a continuous norepinephrine infusion, successfully stabilized her hemodynamics. Anaphylaxis induced by inhalational anesthetics is exceedingly rare and presents a significant diagnostic challenge. This case highlights that in the absence of laboratory confirmation, a presumptive diagnosis can be made through a meticulous assessment of the clinical sequence and other etiologies. It underscores the critical need for vigilance for all anesthetic agents, even those with low allergenic potential, and contributes to the body of evidence for better risk assessment in perioperative anaphylaxis.