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Background and Aims We analyze a case of an unforeseen rare anaphylactic reaction and aim to emphasize the implications in anesthesia practice.

Methods This case details an unusual incident of anaphylactic shock in a healthy 25-year-old woman undergoing arthroscopic meniscectomy. Remarkably, the patient had no prior history of diseases or allergies. The preoperative sciatic and saphenous nerve blocks with 80 mg of 0.2% Ropivacaine, accompanied by light sedation using midazolam (2 mg) and fentanyl (50 mcg), initiated a cascade of unexpected events during the subsequent general anesthesia induction.

Results Following peripheral nerve blocks, induction of general anesthesia with 50 mcg of fentanyl and 150 mg of propofol led to rapid and profound desaturation, indicating severe bronchospasm. Intubation followed, alongside administration of 100 mg of ketamine, 2g of magnesium sulfate, 200 mg of hydrocortisone, and 30 mg of rocuronium intravenously, with additional 300 mcg of adrenaline intramuscular, 400 mcg of salbutamol, and inhaled sevoflurane, resulting in vital signs recovery. Despite ST depression on EKG, myocardial ischemia was absent in subsequent assessments. Postoperatively, successful extubation occurred without neurological deficits.

Conclusions This case underscores the rarity and severity of severe allergic reactions to commonly used anesthetics, necessitating specialized anesthetic approaches for future surgeries. Anesthesiologists must acknowledge the unpredictable nature of such events and respond promptly with tailored interventions. Ongoing education and preparedness are imperative among anesthesiologists to ensure swift and effective management of such cases.