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Rapacuronium and the risk of bronchospasm in pediatric patients
Donna M Rajchert1, Caroline A Pasquariello, Mehernoor F Watcha
1Department of Anesthesiology & Critical Care Medicine, The Children's Hospital of Philadelphia, University of Pennsylvania, Philadelphia 19104-4399, USA. rajchert@email.chop.edu
Insights
Rapacuronium use during anesthesia induction increases bronchospasm risk, especially with rapid sequence induction or reactive airways. Children experiencing bronchospasm were more likely to have received rapacuronium than other muscle relaxants.
Area of Science:
- Anesthesiology
- Pediatric Anesthesia
- Pharmacology
Background:
- Bronchospasm is a critical adverse event during anesthesia induction.
- Rapacuronium is a neuromuscular blocking agent used in anesthesia.
- Identifying risk factors for rapacuronium-induced bronchospasm is crucial for patient safety.
Purpose of the Study:
- To identify risk factors for bronchospasm following rapacuronium administration.
- To compare the likelihood of rapacuronium use in children with bronchospasm versus other muscle relaxants.
Main Methods:
- Retrospective cohort study of patients receiving rapacuronium to identify bronchospasm.
- Case-control study comparing rapacuronium use in bronchospasm cases versus controls during anesthesia induction.
Main Results:
- 12 out of 287 patients (4.2%) developed bronchospasm with rapacuronium.
- Risk factors for rapacuronium-associated bronchospasm included rapid sequence induction (RR 17.9) and reactive airways disease (RR 4.6).
- Children with bronchospasm were significantly more likely to have received rapacuronium (OR 10.1) compared to other muscle relaxants.
Conclusions:
- Rapid sequence induction and a history of reactive airways disease are significant risk factors for bronchospasm with rapacuronium.
- Rapacuronium use is associated with a higher likelihood of bronchospasm during anesthesia induction compared to alternative muscle relaxants.
Unlabelled:
We conducted this study to determine the risk factors for the development of bronchospasm after the administration of rapacuronium and to determine if children with bronchospasm on induction of anesthesia were more likely to have received rapacuronium compared with other muscle relaxants. In a retrospective cohort study, all anesthetic records in which rapacuronium was administered were reviewed to determine which patients developed bronchospasm during induction of anesthesia. Two-hundred-eighty-seven patients were identified, of whom 12 (4.2%; 95% confidence interval [CI], 2.2%--7.2%) developed bronchospasm during induction of anesthesia. Significant risk factors for the development of bronchospasm with administration of rapacuronium included rapid sequence induction (relative risk [RR], 17.9; 95% CI, 2.9--infinity) and prior history of reactive airways disease (RR, 4.6; 95% CI, 1.5--14.3). In a case-control study, all cases of bronchospasm during induction of anesthesia in the 5-mo time period that rapacuronium was available for clinical use were identified. Aside from the 12 cases of bronchospasm with rapacuronium, 11 additional cases of bronchospasm were associated with the use of other muscle relaxants. Four controls were randomly selected for each of the 23 cases of bronchospasm. Children with bronchospasm during induction of anesthesia were several times more likely (odds ratio, 10.1; 95% CI, 3.5--28.8) for having received rapacuronium compared with other muscle relaxants.
Implications:
In a retrospective cohort study, significant risk factors for the development of bronchospasm with the administration of rapacuronium on induction of anesthesia included rapid sequence induction and prior history of reactive airways disease. In a case-control study, children with bronchospasm during induction of anesthesia were several times more likely to have received rapacuronium compared with other muscle relaxants.