Title : Anaphylaxis to indocyanine green during robotic anterior resection: A case report and review of perioperative management
Abstract:
Indocyanine Green (ICG) is widely used intraoperatively for tissue perfusion and vascular assessment. While generally considered safe, rare hypersensitivity reactions, including anaphylaxis, can occur. We report the case of a 58-year-old male undergoing elective robotic anterior resection for rectal adenocarcinoma. Following intravenous ICG administration to assess bowel perfusion, the patient developed sudden hypotension, tachycardia, generalized erythema, and bronchospasm. Immediate management included cessation of ICG, intravenous epinephrine, aggressive fluid resuscitation, corticosteroids, antihistamines, and advanced airway support. Hemodynamic stability was achieved within 20 minutes, and the surgery was successfully completed with adjusted anaesthetic management.
This case emphasizes the importance of early recognition and rapid intervention in ICG-related anaphylaxis. It also highlights the need for thorough preoperative risk assessment and strategies for intraoperative monitoring and management of rare hypersensitivity reactions. Sharing such cases contributes to increasing awareness among anesthesiologists and surgical teams using ICG across colorectal and other major surgeries.
