Related Experiment Video

Updated: May 21, 2025

Author Spotlight: A Non-Intubated Video-Assisted Thoracoscopic Surgery with Multimodal Analgesia and Sevoflurane Inhalation Anesthesia
05:39

Author Spotlight: A Non-Intubated Video-Assisted Thoracoscopic Surgery with Multimodal Analgesia and Sevoflurane Inhalation Anesthesia

Published on: May 26, 2023

1.4K

Perioperative anaphylaxis in children and first successful cisatracurium desensitization

Sophie H Y Lai1,2, Rowena S M Lee3, Crystal K Lam4

  • 1Department of Paediatrics and Adolescent Medicine, Queen Mary Hospital, Hong Kong Special Administrative Region, China.

Pediatric Allergy and Immunology : Official Publication of the European Society of Pediatric Allergy and Immunology
|March 21, 2025
PubMed

Insights

Perioperative anaphylaxis in children is often caused by neuromuscular blocking agents (NMBAs) and beta-lactam antibiotics. Skin testing effectively identifies culprits, and successful desensitization to cisatracurium was achieved.

Area of Science:

  • Anesthesiology
  • Pediatric Allergy and Immunology
  • Clinical Pharmacology

Background:

  • Perioperative anaphylaxis (PA) is a rare but severe complication of anesthesia in children.
  • Diagnosing PA and identifying causative agents is challenging due to limited drug provocation testing (DPT).
  • Desensitization protocols for pediatric PA are not previously reported.

Purpose of the Study:

  • To evaluate diagnostic testing for pediatric PA.
  • To identify common causative agents in pediatric PA.
  • To report the first successful desensitization to cisatracurium in a pediatric patient.

Main Methods:

  • Retrospective review of medical records for pediatric patients (≤18 years) with PA (2019-2024).
  • Analysis of serum tryptase levels, skin testing (ST), and basophil activation testing (BAT).
  • Detailed description of the desensitization protocol for cisatracurium.

Main Results:

  • Neuromuscular blocking agents (NMBAs) (70%) and beta-lactam antibiotics (20%) were the most frequent culprits.
  • Skin testing (ST) identified the culprit in 90% of cases.
  • Successful desensitization to cisatracurium was achieved in one patient with limited drug options.

Conclusions:

  • NMBAs are the primary cause of PA in children, identified effectively by ST.
  • Serum tryptase levels correlate with PA, and BAT serves as an adjunct diagnostic tool.
  • Desensitization to cisatracurium is a viable option for pediatric patients with limited treatment alternatives.
Abstract

Keywords:
allergyanaphylaxisdesensitizationdiagnosisdrug

More Related Videos

Guidelines for Elective Pediatric Fiberoptic Intubation11:19

Guidelines for Elective Pediatric Fiberoptic Intubation

Published on: January 17, 2011

17.4K
Intrathecal Delivery of Antisense Oligonucleotides in the Rat Central Nervous System07:47

Intrathecal Delivery of Antisense Oligonucleotides in the Rat Central Nervous System

Published on: October 29, 2019

18.3K

Related Concept Videos

Depolarizing Blockers: Pharmocokinetics01:19

Depolarizing Blockers: Pharmocokinetics

Depolarizing blockers are administered through intravenous injection. Succinylcholine is the most common choice of depolarizing blockers in emergency clinical practices. Although they have a rapid onset, they readily diffuse away from the motor end plate into the extracellular fluid. They are metabolized by enzymes such as liver butyrylcholinesterase and plasma pseudocholinesterases. This produces a short duration of action, typically 5-10 minutes long, unlike nondepolarizing blockers, which...
299
Allergic Reactions02:06

Allergic Reactions

Overview
27.2K
Parenteral Anesthetics: Overview01:24

Parenteral Anesthetics: Overview

Intravenous anesthetics are drugs administered parenterally to induce anesthesia or sedation. Propofol is a widely used agent formulated as a 1% emulsion in soybean oil, glycerol, and egg phosphatide. It induces rapid anesthesia primarily due to its rapid distribution from the bloodstream to target tissues and is metabolized in the liver. However, it can cause significant pain on injection and hypertriglyceridemia. Fospropofol, a water-based prodrug of propofol, lacks these adverse effects.
91
Skeletal Muscle Relaxants: Adverse Effects01:21

Skeletal Muscle Relaxants: Adverse Effects

Skeletal muscle relaxants are widely used for muscle paralysis and relieving pain following any muscle injury or stiffness. However, depending on the drug type, they can have adverse effects that range from mild to severe. Usually, nondepolarizing neuromuscular blockers have minimal side effects. For example, drugs like d-tubocurarine, cisatracurium, and rocuronium cause hypotension, whereas drugs like baclofen, when stopped abruptly, can lead to the recurrence of spastic conditions.
Unlike...
327
Chemotherapy-Induced Nausea and Vomiting: 5-HT3 Receptor Antagonists01:27

Chemotherapy-Induced Nausea and Vomiting: 5-HT3 Receptor Antagonists

5-HT3 receptor antagonists, such as dolasetron, granisetron (Kytril), ondansetron (Zofran), and palonosetron (Axoli), are crucial in managing chemotherapy-induced nausea and vomiting (CINV) and postoperative nausea. These drugs selectively block 5-HT3 receptors in the visceral vagal and spinal afferent nerves, chemoreceptor trigger zone, and the vomiting center. They have a rapid onset of action and can be given as a single dose before chemotherapy. Ondansetron and granisetron, in particular,...
170
Skeletal Muscle Relaxants: Therapeutic Uses01:31

Skeletal Muscle Relaxants: Therapeutic Uses

Skeletal muscle relaxants are used to relax muscle tone and alleviate painful muscle contractions. However, the choice of skeletal muscle relaxants depends on the duration of the surgical procedure in order to minimize potential side effects. Skeletal muscle relaxants like neuromuscular blocking agents [NMBAs] are commonly employed as adjuvants alongside general anesthetics in clinical settings. NMBAs are also used to maintain controlled ventilation during surgery of the larynx or pharynx...
448