2025 Clinician Corner - Intraoperative cardiac arrest from suspected anaphylaxis to morphine

Abstract 

We report the case of a 62-year-old man who experienced intraoperative anaphylaxis following intravenous morphine administration during head and neck surgery. Immediate resuscitation was successful, and subsequent allergy workup demonstrated a positive skin prick test to morphine. This case underscores the diagnostic complexity of perioperative anaphylaxis and emphasizes the critical role of guideline-directed allergy evaluation in identifying the offending agent and ensuring safe future anesthetic management.    

Keywords:  Allergy; anaphylaxis; morphine; opioids; resuscitation

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Faculty credentials/disclosure 

The planners and faculty for this activity have no relevant financial relationships to disclose. The patient consented to the publication of this report.

Process

Click the "add to cart/begin" button, pay any relevant fee, take the quiz, complete the evaluation, and claim your CME credit.  You must achieve 100% on the quiz with unlimited attempts available.

  • By completing this process, you are attesting that you have read the journal article.

Expiration date:

Credit eligibility for this article is set to expire on November 1, 2026.

Learning Objectives

After completing the article, the learner should be able to:

  • Recognize atypical presentations of perioperative anaphylaxis, especially in the absence of cutaneous or respiratory signs. 

  • Plan safe future anesthetic management in patients with confirmed opioid allergy. 

  • Outline the diagnostic steps, including timing and interpretation of skin testing, in suspected cases of drug-induced anaphylaxis. 

Key Points 

  • Although rare, morphine can trigger IgE-mediated anaphylaxis during surgery. 

  • A multidisciplinary approach ensures safe future anesthetic planning. 

  • Alternative opioid classes may be used safely following comprehensive evaluation. 

  • Skin prick testing is a valuable tool in identifying the offending drug. 

  • Early recognition and epinephrine administration are critical in intraoperative anaphylaxis. 

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Course summary
Available credit: 
  • 1.00 American Board of Internal Medicine (ABIM) MOC Part 2
    Successful completion of this CME activity, which includes participation in the evaluation component, enables the participant to earn up to 1.00 MOC points in the American Board of Medicine’s (ABIM) Maintenance of Certification (MOC) program. It is the CME activity provider’s responsibility to submit participant completion information to ACCME for the purpose of granting ABIM MOC credit.
  • 1.00 American Board of Surgery (ABS) Accredited CME
    Successful completion of this CME activity enables the learner to earn credit toward the CME requirement of the American Board of Surgery’s Continuous Certification program. It is the CME activity provider's responsibility to submit learner completion information to ACCME for the purpose of granting ABS credit.
  • 1.00 AMA PRA Category 1 Credit™
    The A. Webb Roberts Center for Continuing Medical Education of Baylor Scott & White Health is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians.
  • 1.00 Attendance
Course opens: 
11/01/2025
Course expires: 
11/01/2026
Cost:
$25.00
Rating: 
0

Prashant Sirohiya, MD1, Surabhi Sandill, MD1, Surya Theja, DM1, Vasudha Ahuja, MD1, and Smriti Panda, MCh2 

 

1 Department of Onco-anaesthesia and Palliative Medicine, National Cancer Institute, All India Institute of Medical Sciences, New Delhi, India 

2 Department of Head and Neck Surgery and Oncology, National Cancer Institute, All India Institute of Medical Sciences, New Delhi, India 

 

Corresponding author: Prashant Sirohiya, MD, Department of Onco-anesthesia and Palliative Medicine, National Cancer Institute, All India Institute of Medical Sciences, New Delhi (e-mail: [email protected], [email protected]; Twitter Handle: sirohiyap) 

 

The planners and faculty for this activity have no relevant financial relationships to disclose. The authors report no funding. The patient consented to publication of this case report. 

Accreditation

The A. Webb Roberts Center for Continuing Medical Education of Baylor Scott & White Health is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians.

Designation

AMA PRA Category 1 Credit™

The A. Webb Roberts Center for Continuing Medical Education of Baylor Scott & White Health designates this Journal-based CME activity for a maximum of 1.0 AMA PRA Category 1 Credit™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

ABS CC

Successful completion of this CME activity enables the learner to earn credit toward the CME requirement of the American Board of Surgery’s Continuous Certification program. It is the CME activity provider's responsibility to submit learner completion information to ACCME for the purpose of granting ABS credit.

ABIM MOC

 Successful completion of this CME activity, which includes participation in the evaluation component, enables the participant to earn up to 1.0 MOC points in the American Board of Internal Medicine’s (ABIM) Maintenance of Certification (MOC) program. It is the CME activity provider’s responsibility to submit participant completion information to ACCME for the purpose of granting ABIM MOC credit.

 

Available Credit

  • 1.00 American Board of Internal Medicine (ABIM) MOC Part 2
    Successful completion of this CME activity, which includes participation in the evaluation component, enables the participant to earn up to 1.00 MOC points in the American Board of Medicine’s (ABIM) Maintenance of Certification (MOC) program. It is the CME activity provider’s responsibility to submit participant completion information to ACCME for the purpose of granting ABIM MOC credit.
  • 1.00 American Board of Surgery (ABS) Accredited CME
    Successful completion of this CME activity enables the learner to earn credit toward the CME requirement of the American Board of Surgery’s Continuous Certification program. It is the CME activity provider's responsibility to submit learner completion information to ACCME for the purpose of granting ABS credit.
  • 1.00 AMA PRA Category 1 Credit™
    The A. Webb Roberts Center for Continuing Medical Education of Baylor Scott & White Health is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians.
  • 1.00 Attendance

Price

Cost:
$25.00
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