Anaphylaxis to Neuromuscular-blocking Drugs: All Neuromuscular-blocking Drugs Are Not the Same

摘要

In the current issue of Anesthesiology, Reddy et al.1 report a two-hospital, retrospective, observational, cohort study confirming that anaphylaxis is more common with rocuronium and succinylcholine than with atracurium, a topic that is difficult to assess and was first highlighted in this journal in 2003.2 Although any medication can potentially cause perioperative anaphylaxis, neuromuscular-blocking drugs (NMBDs), antibiotics, latex, and chlorhexidine are the most likely to do so. Regional differences regarding the relative risk of allergic reactions to NMBDs do exist. NMBDs represent the dominant causes of anaphylaxis in several countries and regions such as France,2–4 Norway,5 Spain,6 and Australasia,7 whereas other agents may be primarily involved in other countries.8 Nevertheless, allergic reactions to NMBDs remain a serious concern for anesthesiologists because death may occur even when reactions are rapidly and adequately treated.9 The reported incidence of perioperative anaphylaxis is quite varying, ranging between 1:3,500 and 1:20,000. Part of the variability is likely due to difficulty in determining the exact exposures to the numerous drugs, blood products, and agents used in the operative setting. The number of documented cases of intraoperative anaphylaxis is typically reported in aggregate for a large population, leaving the specifics of the total amount and type of medications the population was exposed to in question.