Anaphylactic reactions during anesthesia can have a high mortality. The most common cause of anaphylaxis during anesthesia is neuromuscular blocking agents and, even though considered intermediate risk, rocuronium is frequently involved, probably due to its greater use. We present the case of a woman with anaphylactic shock secondary to the intravenous administration of rocuronium and recovered without complications by early aggressive management combination with conventional methods and sugammadex.

A 70 year old woman with no specific underlying disease was referred to the department of surgery of our hospital to have low anterior resection surgery for rectal cancer. Preoperative transthoracic echocardiography (TTE) revealed perforated fibromuscular septum which divides the left atrium into two chambers. Patients with Cor Triatriatum (CT) can show a clinical feature of mitral stenosis (MS) or tricuspid stenosis (TS) according to the degree of intra atrial membrane fenestration. Therefore careful anesthetic management is needed when we deal with this patients who undergo general anesthesia. Our patient was tolerable throughout the general anesthesia with propofol, volatile agent and opioid. The surgery was done without any hemodynamic event. And there was no postoperative complications.

No abstract

Lambl’s excrescences(LE) are mobile, thin, filiform structures that occur at sites of valve closure. LE are mostly asymptomatic but atheroma from LE may embolize to cerebrovascular arterial territory causing stroke. A 79 year old man with mechanical ileus of small bowel loop and pelvic mass scheduled for palliative enteroenterostomy. His transthoracic echocardiography showed a filiform hyperechoic mass attached to the tip of noncoronary cusp, suggestive of LE. To prevent cardioembolic stroke during perioperative period, we tried to prevent blood pressure fluctuation during surgery. Also we monitored regional cerebral oxygen saturation by cerebral/somatic  oximeter for early detection of cerebral ischemia. A patient had no neurological changes and signs of cerebral infarction after surgery.