Anaphylaxis spares no drug: A report of diclofenac-induced anaphylaxis mimicking post-laparoscopy respiratory complication

Peri-anesthetic anaphylaxis is a rare but grave problem. After receiving informed consent for publication, we discuss the case of a female patient posted for laparoscopic cholecystectomy who developed an anaphylactic reaction to intravenous diclofenac, mimicking post-laparoscopy respiratory complication in the perioperative period. A 45-year-old, American Society of Anesthesiologists physical status (ASA-PS) I, female patient was posted for laparoscopic cholecystectomy under general anesthesia (GA). The procedure took 60 minutes and concluded uneventfully. In the post-anesthesia care unit, the patient complained of respiratory difficulty. Even after the supplemental oxygen and in absence of any significant finding on respiratory examination, the patient soon developed severe cardiorespiratory collapse. On evaluation, administration of intravenous diclofenac a few minutes before the event was suspected as the trigger for this anaphylactic response. The patient responded to the injection of adrenaline, and her post-surgical progress over the next two days was uneventful. The retrospective tests done for confirming diclofenac hypersensitivity were found to be positive. No drug, however safe, should be given blindly without proper observation and monitoring. The course of development of anaphylaxis can range from a few seconds to minutes and hence, the earliest recognition and prompt action can be the only deciding factor between life and death for such patients.