Anaphylactic Shock During Oculofacial Plastic Surgery in a Patient With Midazolam and Tetracaine Allergies.
Rupin N Parikh, Dustin Lode, Brian K Gehlbach et al.
✦ AI-curated · Sources linked
Case in brief
A 56-year-old woman developed facial flushing, hypotension, and oxygen desaturation during elective oculofacial plastic surgery after exposure to tetracaine eye drops, intravenous midazolam and propofol, and a local anesthetic mixture of lidocaine, bupivacaine, and epinephrine. She required intubation, epinephrine, corticosteroid treatment, and intensive care. Tryptase measured 2.5 hours after symptom onset was within the normal range, but subsequent allergy testing was positive for midazolam and tetracaine. She recovered fully, was discharged the next day, and later underwent surgery successfully under general anesthesia.
What made this case unusual
Despite a normal tryptase result, allergy testing identified positive reactions to both midazolam and tetracaine after perioperative anaphylactic shock.
Diagnostic / clinical pearl
A normal tryptase result did not exclude perioperative anaphylaxis in this case; subsequent allergy testing helped identify implicated agents.
Why it matters
The episode highlights the need for procedure rooms to be equipped for prompt intervention, including when suspected triggers are agents not commonly associated with anaphylactic shock.