Anaphylactoid reaction complicating neonatal anaesthesia.

A three-week-old girl presented for surgery for congenital pyloric stenosis. The anaesthetic technique included intravenous induction with thiopentone and neuromuscular blockade with atracurium. The administration of these drugs was followed within 2-3 minutes by oedema of the eyelids and epiglottis, reduced peripheral circulation and central cyanosis. There was no previous exposure to either drug and no definite family history of allergy. Analysis of subsequent sequential blood samples indicated that the reaction mechanism was non-immune and was presumed to be due to pharmacological release of histamine.