Anaphylactoid Reactions After Cisatracurium Administration in Six Patients

Krombach, Jens; Hunzelmann, Nicolas; Koster, Friedrich; Bischoff, A; Hoffmann-Menzel, Helmut; Buzello, W.

doi:10.1097/00000539-200111000-00043

Cited by 45 publications

(15 citation statements)

References 10 publications

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“…As in our cases, many patients with severe anaphylactic reactions were not exposed previously to any NMBA [4-7]. The anaphylaxis may arise due to cross-reactivity to the tertiary and quaternary ammonium ions that are often found in foods, drugs and cosmetics [11].…”

Section: Discussionmentioning

confidence: 95%

“…Early clinical reports suggested that cisatracurium has negligible histamine-releasing potential and is a less potent trigger of allergic reactions than other NMBAs [3]. However, since 1995, several cases of cisatracurium-induced anaphylactic reactions with severe symptoms of cardiovascular collapse and bronchospasm have been reported [4-7]. …”

Section: Discussionmentioning

confidence: 99%

“…Cisatracurium, a relatively new NMBA, is a stereoisomer of atracurium, which does not induce apparent histamine release upon a bolus administration and causes fewer allergic reactions than other NMBAs [3]. However, several cases of anaphylactic reactions of varying severity to cisatracurium have been reported [4-7]. Two cases of severe anaphylactic reactions after cisatracurium administration are reported here.…”

mentioning

confidence: 99%

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Anaphylactic reactions after cisatracurium administration in two patients -a report of two cases-

Yoon

Lee

Seo

et al. 2013

Korean J Anesthesiol

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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.

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Section: Discussionmentioning

confidence: 95%

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

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Anaphylactic reactions after cisatracurium administration in two patients -a report of two cases-

Yoon

Lee

Seo

et al. 2013

Korean J Anesthesiol

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“…[1][2][3] Tracheal intubation without muscle relaxants is possible with varying doses of remifentanil in combination with propofol or thiopental, and optimal conditions for direct laryngoscopic intubation have been investigated. [4][5][6][7] The optimal dose of remifentanil when used with thiopental for lightwand intubation without muscle relaxants has not yet been evaluated.…”

Section: Introductionmentioning

confidence: 99%

Optimal remifentanil dose for lightwand intubation without muscle relaxants in healthy patients with thiopental coadministration

Jeon

Park³

et al. 2012

European Journal of Anaesthesiology

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“…In addition to their intended target, the nicotinic receptor on skeletal muscle, muscle relaxants can initiate bronchoconstriction via histamine release1,2, interaction with airway muscarinic receptors3–7 or anaphylaxis8–10. We have previously demonstrated that muscle relaxants that antagonize pre-junctional parasympathetic M2 muscarinic autoreceptors can potentiate vagal nerve induced bronchoconstriction6, a common event accompanying irritation of the upper airway during intubation and suctioning.…”

Section: Introductionmentioning

confidence: 99%

Gantacurium and CW002 Do Not Potentiate Muscarinic Receptor-mediated Airway Smooth Muscle Constriction in Guinea Pigs

Sunaga¹,

Zhang²,

Savarese

et al. 2010

Anesthesiology

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Background Neuromuscular blocking agents are an integral component of general anesthesia. In addition to their intended pharmacologic target on skeletal muscle nicotinic receptors, undesirable airway effects (i.e. bronchoconstriction) can result from neuromuscular blocking agents affinity for airway muscarinic receptors. We questioned whether two new members of a bisquaternary non-depolarizing muscle relaxant family, gantacurium and CW002, demonstrated detrimental effects of airway muscarinic receptors using an in vivo model in guinea pig airways. Methods Urethane anesthetized male guinea pigs were ventilated through a tracheostomy with continuous digital recordings of pulmonary inflation pressure and heart rate. The ED95 for muscle paralysis for gantacurium, CW002, cisatracurium and rapacuronium were defined in the guinea pig. Transient and reproducible changes in pulmonary inflation pressure and heart rate were recorded following vagal nerve stimulation or the intravenous injection of acetylcholine before and after pretreatment with cumulatively increasing concentrations of gantacurium, CW002, cisatracurium or a single concentration of rapacuronium. Results Gantacurium, CW002, cisatracurium and rapacuronium exhibited ED95 for muscle paralysis of 0.064 ± 0.0006, 0.012 ± 0.006, 0.10 ± 0.003, and 0.31 ± 0.05 mg/kg, respectively. Gantacurium, CW002 and cisatracurium were without effects on baseline pulmonary inflation pressures and were devoid of significant interactions with M2 and M3 muscarinic receptors in vivo. Conclusion These findings suggest that gantacurium and CW002 are devoid of significant effects at airway muscarinic receptors particularly M3 receptors on bronchial smooth musculature at doses several fold higher than those required for functional muscle paralysis.

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Anaphylactoid Reactions After Cisatracurium Administration in Six Patients

Cited by 45 publications

References 10 publications

Anaphylactic reactions after cisatracurium administration in two patients -a report of two cases-

Anaphylactic reactions after cisatracurium administration in two patients -a report of two cases-

Optimal remifentanil dose for lightwand intubation without muscle relaxants in healthy patients with thiopental coadministration

Gantacurium and CW002 Do Not Potentiate Muscarinic Receptor-mediated Airway Smooth Muscle Constriction in Guinea Pigs

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