An Unexpected Perioperative Emergency in Cosmetic Surgery: A Case Report of Anaphylactic Shock

Abstract

Background: Perioperative anaphylaxis may cause rapid cardiovascular deterioration during anaesthetic induction. This report describes an acute reaction in a patient undergoing elective aesthetic surgery and considers diagnostic and management issues through a narrative literature review. Case Presentation: A 32-year-old woman with a documented penicillin allergy was scheduled for abdominal liposuction and gluteal fat grafting. Following induction of general anaesthesia with propofol, fentanyl and rocuronium, she developed sudden profound hypotension and cardiovascular collapse. Immediate management comprised intravenous epinephrine, fluid resuscitation, corticosteroids and antihistamines, followed by admission to the intensive care unit. Cervicofacial erythema was documented, and total serum IgE was 230 IU/mL. The patient recovered following stabilisation and was referred for specialist allergological assessment. Literature review: The reviewed literature identifies several potential perioperative triggers and emphasises prompt recognition, appropriate epinephrine administration, haemodynamic support and subsequent investigation. Administration of several induction agents in close succession makes attribution of the event to a single drug uncertain. Total serum IgE alone cannot identify the causative agent, and confirmatory results from acute and baseline tryptase measurements and subsequent allergological testing were not provided in the case description. Conclusion: This case underscores the importance of readiness for severe hypersensitivity reactions during elective cosmetic procedures, systematic documentation and specialist follow-up to inform the safety of future anaesthetic exposures.