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[Anaphylactoid Reactions Suspected to Be Caused by Neostigmine in Pediatric Patients under General Anesthesia]

Sayo Iwasai, Yoko Kinoshita, Yutaro Asagoe

    Masui. the Japanese Journal of Anesthesiology
    |May 19, 2016
    PubMed

    Insights

    Pediatric patients undergoing retinoblastoma surgery may experience anaphylactoid reactions, a rare allergic response, likely triggered by neostigmine. This highlights the need for vigilance regarding neostigmine's potential adverse effects in children.

    Area of Science:

    • Anesthesiology
    • Pediatric Oncology
    • Allergology

    Background:

    • Anaphylactoid reactions are rare in pediatric patients, with most cases occurring in adults.
    • Retinoblastoma surgery requires general anesthesia, involving various anesthetic agents and reversal drugs.

    Observation:

    • Two pediatric patients developed rapid-onset anaphylactoid reactions post-retinoblastoma surgery.
    • Reactions occurred immediately after neostigmine administration to reverse rocuronium.

    Findings:

    • Patients exhibited skin manifestations (red flare) and respiratory symptoms (wheezes).
    • Neostigmine was identified as the probable causative agent for the anaphylactoid reactions.
    • Vital signs remained relatively stable during the adverse events.

    Implications:

    • This case series underscores the importance of recognizing and managing neostigmine-induced anaphylactoid reactions in pediatric surgical patients.
    • Anesthesiologists should consider neostigmine as a potential trigger for anaphylaxis in children, especially post-retinoblastoma surgery.
    • Further research into the incidence and mechanisms of neostigmine-related anaphylactoid reactions in pediatric populations is warranted.

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