ABSTRACT
We present a case of early skin and challenge testing in a patient following severe anaphylaxis to rocuronium. The patient presented for semi-elective laparoscopic cholecystectomy and developed anaphylaxis with severe cardiovascular collapse after induction of anaesthesia. Surgery was cancelled but was considered necessary before the recommended four to six weeks for formal allergy testing. Limited skin and challenge testing was performed to rocuronium and cisatracurium while the patient was in the intensive care unit to identify a safe neuromuscular blocking drug for subsequent early surgery. The subsequent surgery, 48 hours after the initial reaction, was uneventful. The case highlights the difficulties when anaesthetising patients with recent anaphylaxis who have not yet had formal allergy testing and presents a potential management strategy involving early skin testing.
Subject(s)
Anaphylaxis/chemically induced , Androstanols/adverse effects , Neuromuscular Nondepolarizing Agents/adverse effects , Adolescent , Anaphylaxis/diagnosis , Anaphylaxis/immunology , Androstanols/immunology , Atracurium/adverse effects , Atracurium/analogs & derivatives , Atracurium/immunology , Cholecystectomy, Laparoscopic/methods , Female , Humans , Neuromuscular Nondepolarizing Agents/immunology , Rocuronium , Skin TestsABSTRACT
We report two cases of severe anaphylactic reactions to rocuronium. Diagnosis was confirmed by skin tests and specific IgE assay. Cross-reactivity to all neuromuscular blocking agents was investigated by intradermal tests and leucocyte histamine release test. Intradermal tests and leukocyte histamine release were negative for cisatracurium. The two patients had undergone a subsequent general anaesthesia using cisatracurium and did not present any adverse reaction.
Subject(s)
Androstanols/adverse effects , Anesthesia, General , Drug Hypersensitivity/diagnosis , Drug Hypersensitivity/therapy , Neuromuscular Nondepolarizing Agents/adverse effects , Aged , Anaphylaxis/physiopathology , Androstanols/immunology , Atracurium/immunology , Cross Reactions , Histamine Release/drug effects , Humans , Immunoglobulin E/analysis , Leukocytes/drug effects , Leukocytes/metabolism , Male , Middle Aged , Neuromuscular Nondepolarizing Agents/immunology , Rocuronium , Skin TestsSubject(s)
Anaphylaxis/etiology , Atracurium/adverse effects , Neuromuscular Nondepolarizing Agents/adverse effects , Acrylates/adverse effects , Acrylates/immunology , Acrylates/metabolism , Atracurium/immunology , Atracurium/pharmacokinetics , Biotransformation , Humans , Neuromuscular Nondepolarizing Agents/immunology , Neuromuscular Nondepolarizing Agents/pharmacokineticsABSTRACT
Seventy-five consecutive patients referred to an anaesthetic allergy clinic were intradermally tested with atracurium and cisatracurium. With the exception of one patient the results were identical, suggesting that allergy to either drug is associated with allergy to the stereoisomer. For skin testing for allergy to neuromuscular blocking drugs it is only necessary to use either atracurium or cisatracurium and cisatracurium is the preferred drug.
