Intraoperative vecuronium anaphylaxis compounded by latex hypersensitivity.

Background: Anaphylaxis to latex or muscle relaxant drugs has been demonstrated in the perioperative period but there are no reports of a patient with anaphylaxis to both of these substances.

Methods: We report a patient with meningomyelocele who was initially thought to have anaphylaxis to latex during induction of anesthesia. After recurrence of anaphylaxis following removal of latex as the suspected agent, the muscle relaxant vecuronium was found to be the actual etiology.

Results: Skin testing to several muscle relaxants and other anesthetic medications confirmed a hypersensitivity to vecuronium. Skin testing and subsequent physical contact with latex also established a hypersensitivity to this substance.

Conclusions: This report demonstrates the need to scrutinize closely every notation in the anesthesia record when evaluating perioperative anaphylaxis and to consider that hypersensitivity to more than one substance may be present.