Mortality, morbidity, and impact on future anaesthesia after perioperative anaphylaxis related to neuromuscular blocking agents: an 11-year single-centre retrospective study

Few data are available regarding the morbidity of patients who have experienced anaphylaxis because of neuromuscular blocking agents (NMBAs). This study aimed to describe the outcomes and impact on future anaesthesia in these patients.

This retrospective single-centre study analysed data from adult patients receiving NMBAs during general anaesthesia from 2012 to 2022 at Lille University Hospital (Lille, France) who also experienced a grade II, III, or IV NMBA-related anaphylaxis. Data were collected using an electronic data warehouse and through individual review of medical records.

Among the 158 021 general anaesthetics including an NMBA, 94 patients experienced perioperative anaphylaxis, with 82 confirmed by an allergist. This incidence of 58.1 reactions per 100 000 administrations of NMBAs, all agents combined, is higher than that described in the literature. Reporting to a pharmacovigilance centre occurred in only 14.9% of cases. Four patients died within 90 days, and 19 patients (20%) experienced morbidity, including renal failure (n=12), cardiovascular complications (n=8), and neurological complications (n=4). Out of those 19 patients with morbidity, 12 made a full recovery. In the 96 subsequent anaesthetic procedures screened, surgery was successfully completed without the use of NMBAs.

This study highlighted a significant underestimation of the incidence of perioperative anaphylaxis related to neuromuscular blocking agents and reporting to the local and national pharmacovigilance centre despite allergy assessment. Morbidity occurred in 20% of patients, primarily involving renal and cardiovascular complications, with most patients making a full recovery. The impact on subsequent anaesthesia is limited, as procedures can typically be performed without use of neuromuscular blocking agents.