Anaphylaxis in Perioperative Anaesthesia

perioperative anaphylaxis Caused by Neuromuscularblocking drugs

Immediate hypersensitivity reactions during anaesthesia are rare but potentially life-threatening. Neuromuscular blocking drugs are the most common cause of perioperative anaphylaxis.

A French retrospective, observational study on patients who had experienced a hypersensitivity reaction-during anaesthesia between 1 January 2011 and 31 December 2012 conducted by GERAP members showed that the most common causes of allergic reactions were neuromuscular blocking agents (N = 302; 60.6%). Of the neuromuscular blocking agents, rocuronium had the highest proportion of reactions (13.8 reactions /100,000 vials sold) followed by suxamethonium (13.3/100,000 vials sold). Cisatracurium had the lowest proportion of reactions (0.4/100,000 vials sold). Another French pharmacovigilance survey on neuromuscular blocking agents induced anaphylaxis from 2000 to 2012 found that suxamethonium and rocuronium were markedly more involved in perioperative anaphylaxis than the other available neuromuscular blocking agents, incidence rates of suxamethonium and rocuronium were 10- and 13-folds higher than those of the others neuromuscular blocking agents, respectively.

A retrospective analysis of patients in Belgium with the suspicion of an allergic reaction during or shortly after general anaesthesia from 2007 to 2011 concluded asimilar result that rocuronium was the most frequently causative neuromuscular blocking agent (48.9%).

Neuromuscular blocking drugs are the most common cause of intraoperative anaphylaxis in Western Australia. In a survey conducted in Western Australia from 2002 to 2011, agents were ranked according to the prevalence of cross-reactivity in patients with previous neuromuscular blocking agent anaphylaxis. Rocuronium was responsible for 56% of cases of neuromuscular blocking agent anaphylaxis, succinylcholine 21%, and vecuronium 11%. Rocuronium has a higher rate of IgE-mediated anaphylaxis compared with vecuronium, cisatracurium had the lowest rate of cross-reactivity in patients who had previously suffered anaphylaxis to rocuronium or vecuronium.

A historical cohort study conducted in a tertiary public hospital in Spain over a 20-yearperiod found that neuromuscular blocking agents accounted for 15.4% anaphylaxis.

A research on perioperative anaphylaxis across Japanese hospitals found that an approximate incidence of perioperative anaphylaxis was 0.01%, and rocuronium was the most commonly suspected trigger, followed by sugammadex, latex, and angiography contrast agents.

For more information please refer to:

1. C. Tacquard, O. Collange, P. Gomis. Anaesthetic hypersensitivity reactions in France between 2011 and 2012: the 10th GERAP epidemiologic survey. Acta Anaesthesiol. Scand. 2017; 61(3): 290-299.

2. J. Antunes, A-M Kochuyt, J. L. Ceuppens. Perioperative allergic reactions: experience in a Flemish referral centre. Allergol. Immunopathol. (Madr). 2014; 42(4):348-54.

3. N. Petitpain, L. Argoullon, K. Masmoudi.Neuromuscular blocking agents induced anaphylaxis: Results and trends of a French pharmacovigilance survey from 2000 to 2012. Allergy. 2018; 73(11): 2224-2233.

4. P. H. M. Sadleir, R. C. Clarke, D. L. Bunning. Anaphylaxis to neuromuscular blocking drugs: incidence and cross-reactivity in Western Australia from 2002 to 2011.Br. J. Anaesth. 2013; 110(6): 981-7.

5. F. Escolano, J. Yelamos, L. Moltó. Severe perioperative anaphylaxis: Incidence in atertiary hospital in Spain over a 20-year period. A historical cohort study. Rev. Esp. Anestesiol. Reanim. (Engl Ed). 2023; 70(1):17-25.

6. Yasuyuki Suzuki, Shuang Liu, Natsumi Yamashita. Perioperative Anaphylaxis in Japanese Secondary Care Institutions: Incidence, Causes, and the Imperative for Improved Diagnostic Practices. Cureus. 2024; 16(4): e57555.