Anaphylactic reactions after cisatracurium administration in two patients: a report of two cases.
10.4097/kjae.2013.65.2.147
- Author:
Yangin YOON
1
;
Byungdoo LEE
;
Hyung Seok SEO
;
Jiyoun BANG
;
Seung Il HA
;
Jun Gol SONG
Author Information
1. Department of Anesthesiology and Pain Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea. seungilha@amc.seoul.kr
- Publication Type:Case Report
- Keywords:
Anaphylaxis;
Cisatracurium;
General anesthesia;
Neuromuscular blocking agents
- MeSH:
Anaphylaxis;
Anesthesia, General;
Anesthetics;
Atracurium;
Bronchial Spasm;
Humans;
Hypotension;
Intradermal Tests;
Ions;
Lidocaine;
Midazolam;
Neuromuscular Blocking Agents;
Piperidines;
Propofol;
Quaternary Ammonium Compounds;
Skin
- From:Korean Journal of Anesthesiology
2013;65(2):147-150
- CountryRepublic of Korea
- Language:English
-
Abstract:
Cisatracurium was initially characterized to have no evident histamine-releasing potential with excellent cardiovascular stability. However, severe anaphylactic reactions to cisatracurium that resulted in bronchospasms and cardiovascular collapse have been reported worldwide. Two cases of severe anaphylactic reactions after the administration of cisatracurium are presented. The anesthetics used in both cases were lidocaine, midazolam, propofol (microemulsion propofol in the second case), remifentanil and cisatracurium. After the administration of these drugs, bronchospasm and hypotension manifested, leading to the diagnosis of anaphylaxis and appropriate treatment. Skin intradermal testing confirmed that both cases were due to immune-mediated anaphylaxis to cisatracurium, despite the fact that neither of the patients had been exposed to the allergen previously. The anaphylaxis may be due to cross-reactivity between neuromuscular blocking agents and substances with quaternary ammonium ions. Anesthesiologists should be aware that cisatracurium has the potential to trigger severe anaphylactic reactions via an immune-mediated mechanism.
