Articles: neuromuscular-blocking-agents-adverse-effects.
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Eur J Phys Rehabil Med · Mar 2008
Case ReportsHeterotopic ossification due to neuromuscular blocking agent in adult respiratory distress syndrome. A case report.
Heterotopic ossification (HO) is the formation of mature bone in soft tissues, which can be seen either in cases of traumatic injury or nontraumatic conditions. HO is more commonly observed after a traumatic event, such as a spinal cord injury or head injury. ⋯ Patients with adult respiratory distress syndrome (ARDS) are at risk of developing HO, due to a prolonged mechanical ventilation period and exposure to neuromuscular blocking agents. In this case report, the authors describe a 51-year-old woman with ARDS, whose HO developed after long-term sedation with neuromuscular blockade agents.
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Neuromuscular blocking agents are the leading drugs responsible for immediate hypersensitivity reactions during anaesthesia. Most hypersensitivity reactions represent IgE-mediated allergic reactions. Their incidence is estimated to be between 1 in 3,000 to 1 in 110,000 general anaesthetics. ⋯ There is no demonstrated evidence supporting systematic pre-operative screening in the general population at this time. However, since no specific treatment has been shown to reliably prevent anaphylaxis, allergy assessment must be performed in all high-risk patients. In view of the relative complexity of allergy investigation, and of the differences between countries, an active policy to identify patients at risk and to provide any necessary support from expert advice to anaesthetists and allergologists through the constitution of allergo-anaesthesia centres in every country should be promoted.
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Randomized Controlled Trial
Pholcodine exposure raises serum IgE in patients with previous anaphylaxis to neuromuscular blocking agents.
Neuromuscular blocking agents (NMBAs) can cause anaphylaxis through immunoglobulin E (IgE) antibodies that bind quaternary ammonium ion epitopes. These epitopes are present in numerous common chemicals and drugs, exposure to which, theoretically, could be of importance in the development and maintenance of the IgE sensitization promoting allergic reactions. Pholcodine is one such drug, which in a recent pilot study was shown to induce a remarkable increase in serum IgE levels in two IgE-sensitized individuals. The present study explores the effect of pholcodine exposure on IgE in a population with previously diagnosed IgE-mediated anaphylaxis towards NMBAs. ⋯ Serum levels of IgE antibodies associated with allergy towards NMBAs increase significantly in sensitized patients after exposure to cough syrup containing pholcodine. Availability of pholcodine should be restricted by medical authorities because of the potential risk of future allergic reactions to muscle relaxants.