Seconds to React: Life-Threatening Rocuronium Anaphylaxis in a High-Risk Bariatric Candidate

Authors

  • Dr. Roly Mishra MBBS, DNB Anaesthesia, FIACTA Associate Consultant, Department of Cardiac Anaesthesia Fortis Escorts Heart Institute New Delhi-110024 India. Author
  • Nitu Kumari MBBS, DNB Anaesthesia, Senior Consultant, Department of Anaesthesia and Pain Management, Sir HN Reliance Foundation Hospital and Research Centre, Mumbai, Maharashtra, India Author
  • Hemant Mehta MBBS, MD Anaesthesia, Director and Head of the Department of Anaesthesia and Pain Management, Sir HN Reliance Foundation Hospital and Research Centre, Mumbai, Maharashtra, India Author

DOI:

https://doi.org/10.47363/JSAR/2026(7)258

Keywords:

Rocuronium, Perioperative Anaphylaxis, Neuromuscular Blocking Agents, Bariatric Anaesthesia, IgEMediated Hypersensitivity, Intraoperative Emergency

Abstract

Anaphylaxis during anesthesia is rare but potentially fatal. Neuromuscular Blocking Agents (NMBAs), particularly rocuronium, are among the most common triggers. We present the case of a 40-year-old male undergoing bariatric surgery who developed severe anaphylaxis immediately after Rocuronium administration during induction. The patient exhibited sudden hypotension, bronchospasm, and generalized urticaria. Rapid diagnosis and management with epinephrine, fluids, antihistamines, and corticosteroids resulted in stabilization, and surgery was postponed. Postoperative allergy testing confirmed IgE-mediated hypersensitivity to rocuronium. This case underscores the need for heightened vigilance when administering NMBAs, early recognition of anaphylaxis, and postoperative allergological evaluation in suspected cases.

Author Biographies

  • Dr. Roly Mishra, MBBS, DNB Anaesthesia, FIACTA Associate Consultant, Department of Cardiac Anaesthesia Fortis Escorts Heart Institute New Delhi-110024 India.

    Dr. Roly Mishra, MBBS, DNB Anaesthesia, FIACTA Associate Consultant, Department of Cardiac Anaesthesia Fortis Escorts Heart Institute New Delhi-110024 India.

  • Nitu Kumari, MBBS, DNB Anaesthesia, Senior Consultant, Department of Anaesthesia and Pain Management, Sir HN Reliance Foundation Hospital and Research Centre, Mumbai, Maharashtra, India

    Nitu Kumari, MBBS, DNB Anaesthesia, Senior Consultant, Department of Anaesthesia and Pain Management, Sir HN Reliance Foundation Hospital and Research Centre, Mumbai, Maharashtra, India

  • Hemant Mehta, MBBS, MD Anaesthesia, Director and Head of the Department of Anaesthesia and Pain Management, Sir HN Reliance Foundation Hospital and Research Centre, Mumbai, Maharashtra, India

    Hemant Mehta, MBBS, MD Anaesthesia, Director and Head of the Department of Anaesthesia and Pain Management, Sir HN Reliance Foundation Hospital and Research Centre, Mumbai, Maharashtra, India

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Published

2026-01-09

Versions

Issue

Vol. 7 No. 1 (2026): Volume 7 Issue 1

Section

Articles