Perioperative hypersensitivity to cisatracurium: successful management with a rapid desensitization protocol

Perioperative hypersensitivity reactions to neuromuscular blocking agents (NMBAs) remain diagnostically and therapeutically challenging. We report a 21-year-old woman who developed severe perioperative hypersensitivity during general anaesthesia, with intradermal testing identifying cisatracurium as the most likely culprit agent. Because no unequivocally safe alternative NMBA could be identified, a simplified 3-bag, 5-step desensitization protocol was successfully performed under continuous monitoring. The procedure and subsequent anaesthesia were completed without adverse reactions. This report highlights the diagnostic limitations of perioperative NMBA hypersensitivity and suggests that a simplified desensitization protocol may be a pragmatic risk-reduction strategy for selected high-risk patients requiring urgent anaesthesia.