• Anesthesiology · Jan 2015

    Comparative Study Observational Study

    Anaphylaxis Is More Common with Rocuronium and Succinylcholine than with Atracurium.

    This retrospective, observational cohort study over 6 years from Auckland, New Zealand identified a 10 fold higher incidence of anaphylaxis for rocuronium than for atracurium.

    Also of note, the rate of anaphylaxis to rocuronium was similar to that for suxamethonium.

    Anaphylaxis incidence for the three muscle relaxants were approximately:

    • Atracurium – 1 in 22,500
    • Rocuronium – 1 in 2,500
    • Suxamethonium – 1 in 2,000
    summary
    • Jeffrey I Reddy, Peter J Cooke, Johan M van Schalkwyk, Jacqueline A Hannam, Penny Fitzharris, and Simon J Mitchell.
    • From the Department of Anaesthesia and Perioperative Medicine, North Shore Hospital, Auckland, New Zealand (J.I.R.); Department of Anaesthesia and Perioperative Medicine (P.J.C., J.M.v.S.) and Department of Immunology (P.F.), Auckland City Hospital, Auckland, New Zealand; and Department of Anaesthesiology (J.A.H., S.J.M.), University of Auckland, Auckland, New Zealand.
    • Anesthesiology. 2015 Jan 1;122(1):39-45.

    BackgroundIntraoperative anaphylaxis is a rare but serious occurrence, often triggered by neuromuscular-blocking drugs (NMBDs). Previous reports suggest that the rates of anaphylaxis may be greater for rocuronium than for other NMBDs, but imprecise surrogate metrics for new patient exposures to NMBDs complicate interpretation.MethodsThis was a retrospective, observational cohort study of intraoperative anaphylaxis to NMBDs at two hospitals between 2006 and 2012. Expert anesthetic and immunologist collaborators investigated all referred cases of intraoperative anaphylaxis where NMBDs were administered and identified those where a NMBD was considered responsible. New patient exposures for each NMBD were extracted from electronic anesthetic records compiled during the same period. Anaphylaxis rates were calculated for each NMBD using diagnosed anaphylaxis cases as the numerator and the number of new patient exposures as the denominator.ResultsTwenty-one patients were diagnosed with anaphylaxis to an NMBD. The incidence of anaphylaxis was 1 in 22,451 new patient exposures for atracurium, 1 in 2,080 for succinylcholine, and 1 in 2,499 for rocuronium (P < 0.001).ConclusionsIn Auckland, the rate of anaphylaxis to succinylcholine and rocuronium is approximately 10-fold higher than to atracurium. Previous estimates of NMBD anaphylaxis rates are potentially confounded by inaccurate proxies of new patient exposures. This is the first study to report anaphylaxis rates using a hard denominator of new patient exposures obtained directly from anesthetic records.

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    This article appears in the collection: Anaphylaxis to Rocuronium in Australia & New Zealand.

    Notes

    summary
    1

    This retrospective, observational cohort study over 6 years from Auckland, New Zealand identified a 10 fold higher incidence of anaphylaxis for rocuronium than for atracurium.

    Also of note, the rate of anaphylaxis to rocuronium was similar to that for suxamethonium.

    Anaphylaxis incidence for the three muscle relaxants were approximately:

    • Atracurium – 1 in 22,500
    • Rocuronium – 1 in 2,500
    • Suxamethonium – 1 in 2,000
    Daniel Jolley  Daniel Jolley
     
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