Anesthetic Management of a Patient with Multidrug Allergy and Limited Anesthetic Options Undergoing Multilevel Lumbar Fusion Surgery

Anesthesiologists may encounter dif fi culties when dealing with patients who have multidrug allergies to anesthetic agents. We discuss the perioperative management of a patient with sensitivity to multiple anesthetic agents. A 65-year-old hypertensive female with lumbar canal stenosis was scheduled to undergo elective multilevel lumbar fusion under general anesthesia. The patient did not reveal any drug and food allergies or surgeries in the past during the preanesthetic visit. In the operating room (OR), a fi ve-lead electrocardiogram, a noninvasive blood pressure monitor, and a peripheral pulse oximeter were connected, and baseline vitals were recorded (heart rate: 86 bpm, blood pressure: 130/90mm Hg, oxygen saturation: 100%). The patient was induced with intravenous (IV) fentanyl (2 µg/kg), propofol (2 mg/kg), and cisatracurium (0.2mg/kg). Immediately after tracheal intubation, a high peak airway pressure (40 cm H 2 O) was noted, and systolic blood pressure dropped to 60mm Hg. Diffuse rashes were observed all