Acute epiglottitis in adults

A patient suffered a severe anaphylactic reaction to atracurium. The meachanism of this reaction is not easy to explain as there was no possibility of prior exposure. Serial complement levels were not performed. Cross-sensitisation with some other unknown agent, perhaps cosmetics as has been suggested in the case of anaphylaxis to other neuromuscular blocking drugs, would have to be considered. The successful management of a severe anaphylactic reaction depends upon early recognition and prompt aggressive treatment. The value of establishing intravenous infusions and ECG monitoring prior to induction of anaesthesia is stressed. The role of adrenaline as the drug of choice in the treatment of such cases is also underlined.