Intraoperative anaphylaxis to neuromuscular blocking agents

Cho, Youn J.; Ju, Jae-Woo; Sim, Hyunyee; Lee, Jong Hwan; Hong, Deok Man; Kim, Tae Kyoung; Min, Jeong Jin; Song, Woo Jung; Kang, Hye Ryun; Cho, Sang Heon; Jeon, Yunseok

doi:10.1097/eja.0000000000000373

Cited by 12 publications

(7 citation statements)

References 32 publications

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“…In this study, we did not find cases of sugammadex-induced anaphylaxis in our institution cohort; however, this cannot be attributed to underreporting in our EMR-based surveillance system as we identified 11 cases of rocuronium-induced anaphylaxis using the same search protocol. The incidence of rocuronium-induced anaphylaxis in this data was calculated at 4.9/100,000, which is in the range of that reported in previous studies [ 24 , 25 ].…”

Section: Discussionsupporting

confidence: 74%

Estimated Incidence of Sugammadex-Induced Anaphylaxis Using the Korea Adverse Event Reporting System Database

Kim

Yang

et al. 2021

JCM

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We aimed to investigate the incidence of sugammadex-induced anaphylaxis in a large Korean population. We retrospectively investigated the incidence of sugammadex-induced anaphylaxis between 2013 and 2019 from the database of the Korea Institute of Drug Safety-Risk Management-Korea Adverse Event Reporting System (KIDS-KAERS). We estimated the incidence of sugammadex-induced anaphylaxis from the KIDS-KAERS database, assuming that the reporting efficiency was 10%, 50%, and 100%, respectively. We also investigated its annual sales volume in Korea and assumed that the exposure to sugammadex was 95% of the estimated sales volume. During the study period, 1,401,630 sugammadex vials were sold, and 19 cases of sugammadex-induced anaphylaxis were identified in the KIDS-KAERS database. The estimated incidence of sugammadex-induced anaphylaxis was 0.0143%, 0.00279%, and 0.0014%, assuming a reporting efficiency of 10%, 50%, and 100%, respectively. All patients, except for one with a missing record, fully recovered after anaphylaxis. The incidence of sugammadex-induced anaphylaxis identified in the national pharmacovigilance database was lower than previously reported rates in other countries. Therefore, its use in general anesthesia should not be hindered by concerns about the resulting risk of anaphylaxis in Korea.

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Section: Discussionsupporting

confidence: 74%

Estimated Incidence of Sugammadex-Induced Anaphylaxis Using the Korea Adverse Event Reporting System Database

Kim

Yang

et al. 2021

JCM

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“…32 Among NMBAs, rocuronium is one of the most likely medications to cause anaphylaxis. 5,7,10,27,33 Evidence shows that rocuronium-induced anaphylaxis can be IgE-mediated. [34][35][36] In France, a patient died one week after rocuronium-induced anaphylaxis.…”

Section: Rocuronium-induced Anaphylaxismentioning

confidence: 99%

“…Tertiary and quaternary ammonium groups of NMBAs can function as antigenic epitopes capable of binding to IgE 31 and cause the release of histamine after the clinical administration of NMBAs 32 . Among NMBAs, rocuronium is one of the most likely medications to cause anaphylaxis 5,7,10,27,33 …”

Section: Rocuronium‐induced Anaphylaxismentioning

confidence: 99%

“…Nonetheless, the risk per exposure likely lies between 0.04% 5 and 0.004%, 10 with the lower frequencies representing only severe instances of anaphylaxis. 5,7,10 Rocuronium-induced anaphylaxis is a diagnostic challenge because this medication is commonly administered in conjunction with others that also can produce anaphylaxis (eg, antibiotics, induction agents), and it can present during surgery with symptoms that could have multiple causes (eg, hypotension, bronchospasm). 11 However, patient safety concerns dictate that perioperative personnel recognize rocuronium-induced anaphylaxis promptly and treat it correctly 12 because onset occurs rapidly (eg, within minutes) with little warning and it can be life-threatening.…”

mentioning

confidence: 99%

“…It is difficult to determine the exact risk of rocuronium‐induced anaphylaxis per patient exposure because the number of procedures for which the medication is administered (ie, the denominator for a risk calculation) may not be precisely known, and the definition used to identify cases of anaphylaxis (ie, the numerator) may vary. Nonetheless, the risk per exposure likely lies between 0.04% 5 and 0.004%, 10 with the lower frequencies representing only severe instances of anaphylaxis 5,7,10 …”

mentioning

confidence: 99%

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Rocuronium‐Induced Anaphylaxis in the Perioperative Period: A Clinical Review

Harris

2023

AORN Journal

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Rocuronium, a nondepolarizing neuromuscular blocking agent used for muscle relaxation especially during endotracheal intubation, can cause hypersensitivity reactions. This article provides an overview of anaphylactic reactions; risk factors; and the pathophysiology, presentation, diagnosis, treatment, and nursing implications associated with rocuronium‐induced anaphylaxis. Life‐threatening anaphylaxis can be immunoglobulin E–mediated or non–immunoglobulin E‐mediated and usually occurs after the first dose. Anaphylaxis can present with hypotension and bronchospasm; cutaneal symptoms, such as erythema, may not be obvious. Diagnosis is initially presumptive and may require a transesophageal echocardiogram to rule out other causes of hypotension (eg, pulmonary embolus). Emergency treatment begins with epinephrine administration and fluid boluses; cardiac support devices may be needed. Definitive diagnosis requires early measurement of histamine and tryptase levels and skin testing after the patient recovers from the reaction. Perioperative nurses should be prepared to participate in emergency treatment of anaphylaxis and advocate for testing for a definitive diagnosis.

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Cisatracurium-besilate/rocuronium-bromide/vecuronium-bromide

2017

Reactions Weekly

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Intraoperative anaphylaxis to neuromuscular blocking agents

Abstract: Among commonly used NMBAs, rocuronium appears to have the highest incidence of anaphylaxis. Our findings suggest that future prospective investigation for NMBA-induced anaphylaxis should use internationally agreed skin test protocols.

Cited by 12 publications

References 32 publications

Estimated Incidence of Sugammadex-Induced Anaphylaxis Using the Korea Adverse Event Reporting System Database

Estimated Incidence of Sugammadex-Induced Anaphylaxis Using the Korea Adverse Event Reporting System Database

Rocuronium‐Induced Anaphylaxis in the Perioperative Period: A Clinical Review

Cisatracurium-besilate/rocuronium-bromide/vecuronium-bromide

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