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Rocuronium anaphylaxis and multiple neuromuscular blocking drug sensitivities
P Matthey1, P Wang, B A Finegan
1Department of Anesthesia, Walter C. Mackenzie Health Sciences Centre, University of Alberta, Edmonton, Canada. pmatthey@ualberta.ca
Canadian Journal of Anaesthesia = Journal Canadien D'Anesthesie
|September 16, 2000
Summary
Anaphylaxis to rocuronium occurred in a patient with no prior exposure to neuromuscular blocking drugs. Testing revealed cross-reactivity with other muscle relaxants, highlighting the need for comprehensive allergy evaluation.
Area of Science:
- Anesthesiology
- Clinical Immunology
Background:
- Anaphylaxis during general anesthesia is a serious adverse event.
- Neuromuscular blocking drugs (NMBDs) are a common cause of anesthetic anaphylaxis.
Observation:
- A patient experienced profound hypotension and airway difficulties immediately after rocuronium administration.
- Skin prick testing demonstrated hypersensitivity to rocuronium, vecuronium, and pancuronium, indicating cross-reactivity.
Findings:
- Muscle relaxants account for a significant percentage of anaphylaxis cases during general anesthesia.
- Cross-reactivity among NMBDs is frequent due to shared chemical structures (quaternary ammonium group).
Implications:
- Mandatory testing for the causative agent and cross-reactivity is crucial after anaphylactic reactions to NMBDs.
- A standardized protocol for investigating suspected anaphylaxis to muscle relaxants should be implemented.
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