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Clipping of Cerebral Aneurysm in a Patient with Coarctation of Aorta: Anesthetic Management

THIEME In our case, during the event, the MAC of sevoflurane was 1.5 whereas fentanyl <2 μg/kg was administered 5 minutes earlier and the child was being ventilated adequately. However, within 2 minutes of administering the intubating dose of cisatracurium and prior to laryngoscopy and any neck or airway manipulation the child developed sudden severe bradycardia. The fall in HR was not gradual over a period of time, but sudden, severe, and sustained after administration of cisatracurium, which reverted only after atropine was administered. After excluding all other causes, anaphylactic or anaphylactoid reaction following cisatracurium appears to be the possible cause for sudden severe bradycardia in our case. Although we did not assess serum tryptase/plasma histamine levels or perform immunoglobulin-E (IgE) assay in this case to confirm the diagnosis of anaphylactic reaction, we suggest laboratory testing to confirm the diagnosis even if there is an isolated symptom, such as bradycardia, and making a note of this in the medical record of the patient for future. In literature, there are few reports of anaphylactic reaction (bradycardia, hypotension, cutaneous flushing, and bronchospasm) after administration of cisatracurium.7 However, isolated bradycardia has not been described. Although cisatracurium has a safe cardiovascular profile, this case highlights a rare and serious complication and delivers a word of caution regarding its use, especially in pediatric patients. Funding None.