• Akihiro Yokoyama, Motohiro Sekino, Taiga Ichinomiya, Hironori Ishizaki, Keiko Ogami-Takamura, Takashi Egashira, Rintaro Yano, Sojiro Matsumoto, Ushio Higashijima, and Tetsuya Hara.
• Department of Anesthesiology and Intensive Care Medicine, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan.
• Medicine (Baltimore). 2021 Sep 3; 100 (35): e27135e27135.

RationaleWe present the first case of a patient with severe aortic stenosis who developed anaphylactic shock and was successfully treated with adrenaline and landiolol, a highly selective β1-receptor blocker, to prevent disruption of the myocardial oxygen supply-demand balance caused by tachycardia.Patient ConcernsAn 86-year-old woman was scheduled for simultaneous anterior-posterior fixation for a burst fracture of the 12th thoracic vertebra; 200 mg sugammadex, a neuromuscular blocking agent antagonist, was administered postoperatively, and she was extubated without complications. However, 6 min after extubation, her blood pressure decreased abruptly to 55/29 mm Hg, and her heart rate increased to 78 bpm. Then, we intervened with fluid loading, an increased dose of noradrenaline, and phenylephrine administration. However, her blood pressure did not increase.DiagnosesA general observation revealed urticaria on the lower leg; thus, we suspected anaphylactic shock due to sugammadex administration.InterventionsWe carefully administered 2 doses of 0.05 mg adrenaline and simultaneously administered landiolol at 60 μg/kg/min to suppress adrenaline-induced tachycardia. Adrenaline administration resulted in a rapid increase in blood pressure to 103/66 mm Hg and a maximum heart rate of 100 bpm, suppressing excessive tachycardia.OutcomesThe patient's general condition was stable after the intervention, and circulatory agonists could be discontinued the following day. She was discharged from the intensive care unit on the fourth postoperative day.LessonsLandiolol may help control the heart rate of patients with aortic stenosis and anaphylactic shock. The combined use of landiolol and adrenaline may improve patient outcomes; however, their efficacy and risks must be evaluated by studying additional cases.Copyright © 2021 the Author(s). Published by Wolters Kluwer Health, Inc.

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