Differential Diagnosis for Anaphylactic Reaction during Laparoscopic Cholecystectomy

• Single most likely diagnosis

  • Rocuronium: This is a neuromuscular blocking agent commonly used in general anesthesia. Rocuronium is known for its potential to cause anaphylactic reactions, which can manifest as difficulty ventilating the patient, along with a diffuse maculopapular rash and urticaria, fitting the symptoms described.

• Other Likely diagnoses

  • Latex: Although less common with the increased use of latex-free products in hospitals, latex allergy can cause severe anaphylactic reactions, including respiratory distress and skin manifestations. Given the patient's inability to provide a medical history, a pre-existing latex allergy cannot be ruled out.
  • Cefazolin: This antibiotic is often administered prophylactically before surgery. While less common than reactions to neuromuscular blockers, antibiotics like cefazolin can cause anaphylaxis, especially in patients with a history of allergy to penicillin or other beta-lactam antibiotics.

• Do Not Miss (ddxs that may not be likely, but would be deadly if missed.)

  • Sevoflurane: Although rare, volatile anesthetics like sevoflurane can cause anaphylactic reactions. Given the severity of anaphylaxis and the potential for cross-reactivity among anesthetic agents, it's crucial not to miss this possibility.
  • Propofol: While propofol is less commonly associated with anaphylaxis compared to neuromuscular blockers, it is still a potential culprit, especially in patients with an allergy to egg or soy products, as propofol contains egg lecithin and soybean oil.

• Rare diagnoses

  • Other medications or substances used during the procedure that are less commonly associated with anaphylaxis, such as antiseptics, dyes, or other drugs, could potentially be the offending agent but are less likely given the context provided.