Anaphylactic Reaction after Cisatracurium

Clendenen, Steven R.; Harper, James V.; Wharen, Robert E.; Guarderas, Juan

doi:10.1097/00000542-199709000-00032

Cited by 45 publications

(16 citation statements)

References 14 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…The case reports illustrate that serious drug reactions associated with the use of rocuronium may appear clinically in two very different ways: in cases 1 and 2 circulatory collapse was the main clinical sign; in case 3 bronchospasm was the dominant sign, without concomittent hypotension. Similar clinical scenarios are described in the literature in conjunction with the use of all other available nondepolarizing muscle relaxants, such as vecuronium ( 9–11), pancuronium ( 12, 13), atracurium ( 14–16), cisatracurium ( 17, 18), and mivacurium ( 19).…”

Section: Discussionmentioning

confidence: 83%

Anaphylactic reactions during induction of anaesthesia using rocuronium for muscle relaxation: A report including 3 cases

Heier

Guttormsen

2000

Acta Anaesthesiol Scand

View full text Add to dashboard Cite

Anaphylaxis during induction of anaesthesia is a dreaded complication with a mortality rate of 3-6%, most frequently associated with the use of muscle relaxants. Current knowledge on this matter is reviewed in relation to the presentation of 3 cases of anaphylaxis and bronchospasm associated with the use of the recently released nondepolarizing muscle relaxant rocuronium. Bronchospasm may be the sole sign of a serious drug reaction, triggered by precipitation of insoluble thiopental crystals when mixed with a muscle relaxant in the intravenous (iv) line. It is recommended that these drugs are administered via different injection ports. The hypotension requires immediate treatment with oxygen, epinephrine and large amounts of iv fluids. Epinephrine infusion may be needed for hours. It is recommended that serum tryptase is measured approximately 2 h after debut of the serious drug reaction. Allergy testing should be performed for all the drugs the patient was exposed to, 4-8 weeks after the incident, and due to cross-reactivity, including all available muscle relaxants. Doctors are urged to inform their patients, and systematically register adverse drug reactions.

show abstract

Section: Discussionmentioning

confidence: 83%

Anaphylactic reactions during induction of anaesthesia using rocuronium for muscle relaxation: A report including 3 cases

Heier

Guttormsen

2000

Acta Anaesthesiol Scand

View full text Add to dashboard Cite

show abstract

“…The Norwegian Medicines Agency proposed that RB be withdrawn from routine practice due to frequent reports of anaphylaxis (Laake and Røttingen 2001), and 41 RB-related anaphylactic incidents were reported in France in a survey between 1994 and 1996 (Heier and Guttormsen 2000). Similar anaphylactic and bronchospasm incidents were described in the literature related to the use of other aminosteroid type muscle relaxants (Mishima and Yamamura 1984;O'Callaghan et al 1986;Farrell et al 1988;Treuren and Buckley 1990;Kumar et al 1993;Baird and Futter 1996;Clendenen et al 1997;Toh et al 1999). On the other hand, RB has been demonstrated to have low developmental toxicity in cultured rat embryos (Karabulut et al 2004).…”

Section: Introductionmentioning

confidence: 92%

In vitro genotoxicity of rocuronium bromide in human peripheral lymphocytes

2011

View full text Add to dashboard Cite

Rocuronium bromide (RB), an aminosteroid type neuromuscular blocking agent, acts by reducing or inhibiting the depolarising effect of acetylcholine on the terminal disc of the muscle cell. To our knowledge, there is no adequate information on the genotoxic effects of RB, up to now. In the present study, possible genotoxic effects of RB have been determined by means of sister chromatid exchange (SCE), chromosome aberration (CA) and micronucleus (MN) analyses in human peripheral blood lymphocytes. The human peripheral blood lymphocytes were exposed to three different concentrations of RB (60, 80 and 100 μg/mL) for 24- and 48-h. In this study, RB increased the frequency of CAs, however, did not increase the frequency of SCEs. RB did not decrease the proliferation index (PI) and mitotic index (MI). Accordingly, RB increased the frequency of micronucleus (MN) but did not decrease the nuclear division index (NDI). Findings from this study suggest that rocuronium bromide is clastogenic but not cytotoxic to cultured human peripheral blood lymphocytes.

show abstract

“…Cisatracurium, a 1 R‐cis 1′ R‐cis isomer of atracurium, has been introduced as an agent practically devoid of unspecific histamine liberation and cardiovascular side‐effects ( 1, 2). A recent study reports one patient developing bradycardia and truncal flushing 2 min after administration of cisatracurium ( 4). Our report summarizes five patients with symptoms ranging from urticaria, bronchospasm, and bradycardia to severe hypotension, revealing in all patients positive skin testing to cisatracurium.…”

Section: Clinical Characteristics and Results Of Skin Testing In Patimentioning

confidence: 99%

Immediate‐type reactions to cisatracurium

Hunzelmann

Kopner

Hani

et al. 1999

Allergy

View full text Add to dashboard Cite

Patient 5. A 58-year-old woman was hospitalized with a generalized itchy vesiculopapular eruption with severe mucosal affection. She was treated with systemic corticosteroids and antibiotics, and the cutaneous lesions cleared within 2±3 weeks. Some weeks before this outbreak, the patient had taken several drugs, including tetrazepam and nabumetone, for lumbar arthralgia. Patch tests. All ®ve patients were patch tested with the GEIDC standard series, tetrazepam, diazepam, bromazepam, and lorazepam, all at 1% pet. Other drugs, such as nabumetone and diclofenac, were also tested. Reading was carried out at 48 and 96 h. Patch tests with tetrazepam were positive (+/++) in all cases and negative with the other substances. Skin tests. Prick and intradermal tests were performed with tetrazepam and diazepam, and read at 15 min and 48 and 96 h, with negative results.Oral challenge tests. Single-blind oral challenge tests with increasing doses of diazepam until an accumulative dosis of 8.75 mg was reached were performed in patients 1, 2, and 3 without ill effect. Patient 4, who treated herself without medical control, reported good tolerance of diazepam and lorazepam. Oral challenge with tetrazepam was not done in any case. Oral challenges with the NSAIDs involved in patients 2, 4, and 5 were negative. We present ®ve cases of generalized cutaneous reactions to tetrazepam. Patients 1±4 were diagnosed with systemic contact dermatitis, and patient 5 was diagnosed with Stevens-Johnson syndrome. Positive patch tests to tetrazepam con®rm the value of this tool in the diagnosis of adverse cutaneous reactions induced by this drug. In our patients, patch tests with other benzodiazepines were negative, and four patients tolerated oral administration of diazepam, a benzodiazepine with great structural homology with tetrazepam. These data, in agreement with those of other authors (1, 3), indicate that there is no cross-reactivity among benzodiazepines. However, Ka Èmpgen et al. (4) found positive patch tests to diazepam in one patient with tetrazepam allergy. Garcia Bravo et al. (2) also found positive patch tests be explained by concomitant sensitization.Since we need more data about crossreactivity among benzodiazepines, patch tests with other benzodiazepines are useful in order to offer a therapeutic alternative, but, in our opinion, tolerance must always be con®rmed by oral challenge.

show abstract

Anaphylactic Reaction after Cisatracurium

Cited by 45 publications

References 14 publications

Anaphylactic reactions during induction of anaesthesia using rocuronium for muscle relaxation: A report including 3 cases

Anaphylactic reactions during induction of anaesthesia using rocuronium for muscle relaxation: A report including 3 cases

In vitro genotoxicity of rocuronium bromide in human peripheral lymphocytes

Immediate‐type reactions to cisatracurium

Contact Info

Product

Resources

About