A 44-year-old woman presented for sentinel node biopsy and segmental mastectomy. After anesthetic induction, a laryngeal mask airway was placed, and ventilation was satisfactory. Three minutes after isosulfan blue dye injection, ventilation became difficult. The laryngeal mask airway was removed, and an endotracheal tube was easily placed. Twenty minutes later, she became hypotensive and unresponsive to phenylephrine, ephedrine, and vasopressin. With erythema and swelling in her arm and chest, low-dose epinephrine was titrated until her mean arterial blood pressure stabilized. Serum tryptase was increased to 27.2 μg/L (normal 0.4–10.9 μg/L).
From the Departments of *Anesthesiology, and †Surgery, University of Florida, Gainesville, Florida.
Accepted for publication December 5, 2013.
The authors declare no conflicts of interest.
Address correspondence to Mark Rice, MD, Department of Anesthesiology, University of Florida, PO Box 100254, 1600 SW Archer Rd., Gainesville, FL 32610. Address e-mail to email@example.com.