TRUE ANAPHYLAXIS TO SUXAMETHONIUM CHLORIDE: A case report

Royston, David; Wilkes, R. G.

doi:10.1093/bja/50.6.611

Cited by 20 publications

(3 citation statements)

References 11 publications

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“…Despite the small numbers of patients studied, this is an important ®nding because of the potential for anaphylaxis during re-exposure to NMBAs. 12 Monneret and colleagues suggest that, in some cases, detecting basophil activation bȳ ow cytometry may be a useful additional test, helpful in detecting the identity of the offending agent. 10 Additional studies will be needed to validate the use of¯ow cytometry in allergy testing.…”

Section: Discussionmentioning

confidence: 99%

Weal and flare responses to intradermal rocuronium and cisatracurium in humans

Levy

Gottge

Szlam

et al. 2000

British Journal of Anaesthesia

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Thirty volunteers underwent intradermal skin testing with increasing concentrations of rocuronium and cisatracurium to evaluate weal and flare responses, and whether either agent would cause mast cell degranulation and sensitization upon re-exposure. We found that intradermal injection of rocuronium and cisatracurium at concentrations > 10(-4) M resulted in positive weal (>8 mm) responses, and positive flare responses at > 10(-4) and > 10(-5) M respectively. Only cisatracurium caused mild to moderate mast cell degranulation, and neither drug caused significant in vitro histamine release from whole blood collected from study subjects 4 weeks after skin testing. Skin testing with rocuronium and cisatracurium should be performed at concentrations < 10(-4) and < 10(-5) M respectively to avoid false-positive responses. The ability of these agents to produce positive weal and flare responses at relatively low concentrations may explain the high incidence of potential reactions reported.

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Section: Discussionmentioning

confidence: 99%

Weal and flare responses to intradermal rocuronium and cisatracurium in humans

Levy

Gottge

Szlam

et al. 2000

British Journal of Anaesthesia

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“…However, succinylcholine does possess some side effects that can limit its use in small subsets of ED patients. These side effects include a rise in serum potassium level, 11 malignant hyperthermia, 12,13 anaphylaxis, [14][15][16] fasciculations, 17 and increases in intracranial, intragastric, and intraocular pressures. 18 Many of the patients at risk for morbidity from these side effects are easy to identify, such as patients with obvious head trauma, penetrating globe injuries, or unstable long bone fractures.…”

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confidence: 99%

A Comparison of Succinylcholine and Rocuronium for Rapid‐sequence Intubation of Emergency Department Patients

Laurin

Sakles

Panacek

et al. 2000

Academic Emergency Medicine

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Abstract. Objective: To compare rocuronium and succinylcholine for rapid-sequence intubation (RSI) in the emergency department (ED). Methods: A oneyear prospective cohort comparison study was performed using a data collection form completed at the time of intubation. Data collected included the reason for the neuromuscular-blocking agent (NMBA) chosen, the time to onset of paralysis, and any complications encountered. Three ten-point numerical descriptor scales recorded the degree of body movement, vocal cord movement, and the physician's overall satisfaction with the extent of paralysis. Results: Succinylcholine was used in 382 patients and rocuronium was used in 138 (26% of all RSI) patients. The mean (Ϯ SD) times of onset of succinylcholine and rocuronium were 39 Ϯ 13 sec and 44 Ϯ 20 sec, respectively (p = 0.04). No patient desaturated and required assisted ventilations while waiting for paralysis to occur. Types of body movements were similar with the two agents, but less frequent with succinylcholine (median = 10, mean = 9.5 Ϯ 1.1) than rocuronium (median = 10, mean = 9.1 Ϯ 1.5) (p = 0.01). Vocal cord movements were similar for succinylcholine (median = 10, mean = 9.2 Ϯ 1.6) and rocuronium (median = 9, mean = 9.0 Ϯ 1.6) (p = 0.15). The physician's overall satisfaction with the extent of paralysis was also higher for succinylcholine (median = 10, mean = 9.4 Ϯ 1.3) than rocuronium (median = 10, mean = 8.8 Ϯ 2.0) (p < 0.01). Only one complication, widening of the QRS complex secondary to succinylcholine use in a patient with unsuspected hyperkalemia, could be attributed to the choice of NMBA. Conclusions: Both succinylcholine and rocuronium produced fast and reliable paralysis for RSI. Although succinylcholine had a faster onset and provided more relaxation, the difference had no clinical significance. Approximately a fourth of ED RSI patients qualified for use of rocuronium using these high-risk criteria. Key words: rapid-sequence intubation; tracheal intubation; neuromuscular-blocking agents; succinylcholine; rocuronium. ACADEMIC EMERGENCY MEDICINE 2000; 7:1362-1369 R APID-sequence intubation (RSI) is a lifesaving procedure developed to quickly and safely secure the airway of a critically ill or injured patient. In the emergency department (ED), RSI is often chosen over other intubation techniques because the simultaneous onset of deep sedation and paralysis, followed rapidly by tracheal intubation, minimizes the risk of pulmonary aspiration of gastric contents. Rapid-sequence intubation has therefore become the technique of choice for the intubation of patients at risk of having full stomachs, such as ED patients. Indeed, several recent studies have shown RSI as the most common method to achieve airway control in the ED.

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“…In the literature, thirty-seven cases of allergy are reported between 1957(Bela-Binda & Valeri, 1971Cardan & Deacu, 1972;Dumas et al, 1975;Dohi & Ogawa, 1973;Edward & Thomas, 1969;Eustace, 1967;Fellini, Bernstein & Zauder, 1963;Fujita, 1970;Gambarelli et al, 1974;Gschaedler & Loeb, 1976;Hainsworth & Bingham, 1970;Jerume, Whittingham & Wilson, 1967;Jonecko, 1960;Katz & Mulligan, 1972;Kepes & Haimonici, 1959;Mandappa, Chandrasekhara & Nelvigi, 1975;Paton, 1957;Pavek, 1977;Poirier, 1975;Pupil & Berna, 1976;Redderson et al, 1971;Royston & Wilkes, 1978;Shelley & Juhlin, 1961;Smith, 1957). The differential diagnosis between non-speeifie histamine release and true anaphylaxis remains in most cases extremely controversial.…”

Section: Discussionmentioning

confidence: 99%

Anaphylaxis due to succinylcholine

Moneret-Vautrin¹,

Laxenaire²,

Moeller³

1981

Clin Experimental Allergy

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Summary The antigen non‐specific release of histamine by synthetic neuromuscular blocking agents is well known, though our review of thirty‐two cases reported in the literature of anaphylactoid reactions to succinylcholine, shows that there is insufficient evidence to determine whether the signs are due to anaphylactic or to anaphylactoid reactions. We have examined thirteen cases in whom evidence of anaphylactic sensitization was examined by direct skin tests (in eleven cases) Prausnitz‐Küstner tests (in five), rabbit basophil degranulation, Shelley test (in twelve) and human basophil degranulation (in seven). These tests were done on two to four occasions, and the optimal period for the first test ascertained to be 6 to 12 weeks after the episode. All eleven patients examined by direct skin tests showed evidence of anaphylactic sensitivity, and in three of five cases the sensitivity could be transferred by the Prausnitz‐Küstner procedure. In one of these P‐K tests there was evidence of both IgE and of IgG S‐TS antibodies (heat‐stable antibody conferring sensitivity for 2 hr). Particular susceptibilities to adverse reactions to this drug appear to be prior drug allergy (in 50% of cases), several previous anaesthetics, and atopy.

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TRUE ANAPHYLAXIS TO SUXAMETHONIUM CHLORIDE: A case report

Cited by 20 publications

References 11 publications

Weal and flare responses to intradermal rocuronium and cisatracurium in humans

Weal and flare responses to intradermal rocuronium and cisatracurium in humans

A Comparison of Succinylcholine and Rocuronium for Rapid‐sequence Intubation of Emergency Department Patients

Anaphylaxis due to succinylcholine

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