Articles: neuromuscular-blocking-agents-adverse-effects.
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Acta Anaesthesiol Scand Suppl · Jan 1994
Adverse reaction to neuromuscular blockers: frequency, investigation, and epidemiology.
A survey is presented of neuromuscular drug involvement in 390 clinically severe anaphylactoid reactions (grades II-IV reported to a Sheffield laboratory from 1988 to the end of 1992 from hospitals throughout the UK. Despite advances in patient monitoring and newer drugs, the reporting frequency and individual drug involvement were remarkably similar to those of a previous report from the laboratory in 1988. The highly immunogenic drug suxamethonium still predominated (48% of reports), but there was now much reduced use of the similarly immunogenic drug, alcuronium. ⋯ The remaining reactions were judged to be non-immune, although most involved mast cell degranulation. These reactions were no less hazardous than Type 1 reactions (one death), and two deaths were recorded. The importance of laboratory investigation as a feature of postreaction care is emphasized.
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Arch Phys Med Rehabil · Sep 1993
Case ReportsProlonged paralysis after neuromuscular junction blockade: case reports and electrodiagnostic findings.
Previous reports have described prolonged paralysis after treatment with neuromuscular junction (NMJ) blocking agents in critically ill patients. The purpose of this study was to describe the clinical and electrodiagnostic findings in 12 such patients. All patients developed prolonged and often profound weakness with no sensory loss after discontinuation of NMJ blockers. ⋯ Repetitive nerve stimulation demonstrated no decrement or increment in most patients, with a decrement to 3 Hz stimulation in one patient. Needle examination showed frequent fibrillation potentials and normal or low amplitude, short duration, polyphasic motor units. Physicians prescribing NMJ blockers in critically ill patients should be made aware of this potential complication and of the other agents (ie, corticosteroids) that may exacerbate the problem.
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Ann Fr Anesth Reanim · Jan 1993
Predictive value of in vitro tests for the IgE-dependent and the IgE-independent anaphylactoid reactions to muscle relaxants.
Several aspects of in vitro tests for life-threatening anaphylactoid reactions (AR) to neuromuscular blockers (NMB, muscle relaxants) were addressed and highlighted. They include topics which have been under study in our centre in the past few years. Already available tests and newly developed ones were assessed for diagnostic and predictive value, as well as for usefulness in understanding of mechanism(s) of AR. ⋯ Lymphocyte stimulation tests may also be useful in such cases. RASTs cannot be advocated for general preoperative screening, as yet. Further development or selection of potentially "susceptible" subpopulations may improve the predictive value of these tests.
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Ann Fr Anesth Reanim · Jan 1993
Multicenter Study Clinical TrialDrugs and other agents involved in anaphylactic shock occurring during anaesthesia. A French multicenter epidemiological inquiry.
An epidemiological inquiry was carried out in departments of anaesthesia and immunology in French University and General Hospitals, as well as among those who were already known to have an allergo-anaesthesia outpatient clinic. This inquiry aimed to find out how many patients had undergone diagnostic investigations after as well as an anaphylactoid reaction during an anaesthetic in 1990 and 1991, as well as the demographic data, the kind of assessment, the accident mechanism and the drugs involved. Twenty-one French centres replied to the questionnaire and a series of 1,585 patients tested over a two-year period was thus collected. ⋯ Among these 1,585 patients, 813 were recognized as having had a reaction of immunological origin (52%). The substances involved were identified in these 813 patients as being muscle relaxants (70%), latex (12.6%), hypnotics (3.6%), benzodiazepines (2.0%), opioids (1.7%), colloids (4.7%), and antibiotics (2.6%). Suxamethonium was responsible for 43% of the IgE-dependent reactions involving a muscle relaxant, vecuronium for 37%, pancuronium for 13%, alcuronium for 7.6%, atracurium for 6.8% and gallamine for 5.6%.(ABSTRACT TRUNCATED AT 250 WORDS)