Severe anaphylactic reaction to atracurium

Gupta, Amrita; Srivastava, Uma; Saxena, A. K.; Mittal, Apurva; Dwivedi, Yogita

doi:10.4103/0253-7613.91896

Cited by 4 publications

(4 citation statements)

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“…Out of 100 fully evaluated, 52 references were included in the analysis as per selection criteria. [ 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 61 62 63 64 ] The flow diagram for the article selection is presented as Figure 1 .…”

Section: Resultsmentioning

confidence: 99%

Drug-induced anaphylactic reactions in Indian population: A systematic review

Patel¹,

Patel²,

Barvaliya³

et al. 2014

Indian Journal of Critical Care Medicine

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Background:Epidemiological data on drug-induced anaphylactic reactions are limited in India and are largely depending on studies from developed countries.Aim:The aim was to analyze the published studies of drug-induced anaphylaxis reported from India in relation with causative drugs and other clinical characteristics.Materials and Methods:The electronic databases were searched for Indian publications from 1998 to 2013 describing anaphylactic reactions. The information was collected for demographics, set up in which anaphylaxis occurred, causative drugs, incubation period, clinical features, associated allergic conditions, past reactions, co-morbid conditions, skin testing, IgE assays, therapeutic intervention and mortality. Reactions were analyzed for severity, causality, and preventability. Data were extracted and summarized by absolute numbers, mean (95% confidence interval [CI]), percentages and odds ratio (OR) (95% CI).Results:From 3839 retrieved references, 52 references describing 54 reactions were included. The mean age was 35.31 (95% CI: 30.52–40.10) years. Total female patients were 61.11%. Majority reactions were developed in perioperative conditions (53.70%), ward (20.37%) and home (11.11%). The major incriminated groups were antimicrobials (18.52%), nonsteroidal antiinflammatory drugs-(NSAIDs) (12.96%) and neuromuscular blockers (12.96%). Common causative drugs were diclofenac (11.11%), atracurium (7.41%) and β-lactams (5.96%). Cardiovascular (98.15%) and respiratory (81.48%) symptoms dominated the presentation. Skin tests and IgE assays were performed in 37.03% and 18.52% cases, respectively. The fatal cases were associated with complications (OR =5.04; 95% CI: 1.41–17.92), cerebral hypoxic damage (OR =6.80; 95% CI: 2.14–21.58) and preventable reactions (OR =14.33; 95% CI: 2.33–87.97).Conclusion:Antimicrobials, NSAIDs, and neuromuscular blockers are common causative groups. The most fatal cases can be prevented by avoiding allergen drugs.

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Section: Resultsmentioning

confidence: 99%

Drug-induced anaphylactic reactions in Indian population: A systematic review

Patel¹,

Patel²,

Barvaliya³

et al. 2014

Indian Journal of Critical Care Medicine

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“…Cases of hypersensitivity reaction following atracurium administration are well documented in human medicine, 9,11,20–22 but no reports exist in veterinary medicine. Numerous other drugs administered in the perioperative period can be responsible for an acute non‐allergic hypersensitivity reaction or allergic anaphylaxis, among which antibiotics, 23–26 opioids, 27,28 iodinated 29 and gadolinium‐based contrast media, 8,30 thiopentone, 31–33 acepromazine, 34,35 dexamethasone, 36 xylazine‐ketamine 37 and rocuronium, 18 just to mention a few.…”

Section: Discussionmentioning

confidence: 99%

A suspected non‐allergic anaphylactic reaction to intravenous administration of atracurium in a dog

Testa

Pawson

Bell

2021

Vet Record Case Reports

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Hypersensitivity reactions are rare events but have the potential to be life-threatening. They are relatively more common during general anaesthesia. This is potentially due to multiple drugs being administered concurrently. An 8-year-old, female neutered Labrador Retriever with bilateral cataracts was anaesthetised for right phacoemulsification. Soon after atracurium administration, the patient's heart rate (HR) increased, alongside decreases in arterial blood pressure and end tidal carbon dioxide (ETCO2). The dog was treated with clorphenamine and ephedrine intravenously (IV), while receiving a crystalloid fluids bolus. After 20 min both HR and blood pressure normalised, and the remainder of anaesthesia and recovery were uneventful. We suspected a non-allergic anaphylactic reaction to atracurium. BACKGROUNDMost drugs administered during general anaesthesia have the potential to elicit allergic or non-allergic anaphylactic reactions. This current terminology, provided by the European Academy of Allergy and Clinical Immunology, 1 replaces the former distinction between anaphylactic and anaphylactoid reactions.Allergic anaphylaxis refers to the involvement of the immune system in the reaction of the body to a foreign antigen. The latter stimulates the production of specific immunoglobulin E (IgE) which binds to receptors on mast cell and basophil membranes. At subsequent exposures, the antigen binds to these specific IgE antibodies triggering the activation of a cascade that leads to the release of mediators such as histamine, cytokines, leukotrienes and prostaglandins and to the upregulation of nitric oxide. 2,3 Clinical manifestations may vary in severity and include signs in the skin (oedema, redness, weals, pruritus), gastrointestinal tract (abdominal pain, nausea, vomiting, diarrhoea), cardiovascular system (increased vascular permeability, vasodilation and hypotension) and respiratory system (increased mucous secretion, increased smooth muscle tone and bronchospasm). 4 Classically, these clinical manifestations were thought to occur only after sensitization via a previous exposure to an antigen. However, due to cross-linkages between drugs and other chemical compounds (toothpaste, detergent, nuts, chestnuts, avocado, cough medication), 5,6 severe anaphylaxis can also occur at first exposure. Examples of drugs that can be responsible for allergic reactions in susceptible individualsThis is an open access article under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non-commercial and no modifications or adaptations are made.

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“…Isolated cutaneous reactions appear to be primarily due to non-IgE mediated anaphylaxis, and severe side effects such as arterial hypotension, bronchospasm, are due to type IgE mediated allergy mechanisms ( 1 , 7 , 8 ). Other side effects may be induced by first cellular mechanisms interleukin-modulated because of topical medication or may occur on common medication and may be locally complicated ( 9-13 ).…”

Section: Discussionmentioning

confidence: 99%

“…Intraoperative anaphylactic reactions may range from mild, erythema-like to anaphylactic shock, with tension crash and bronchospasm (1). Usually, severe allergic reactions which results in vertigo or loss of consciousness is preceded by intense itching, redness and swelling over some body areas, new skin eruption or hives, runny nose, itchy eyes and later on, a feeling of light-headedness, as if the world is turning, then followed by vertigo.…”

Section: Introductionmentioning

confidence: 99%

Postanesthetic skin erythema due to succinylcholine versus atracurium

et al. 2020

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Intraoperative anaphylactic reactions may range from mild, erythema-like to anaphylactic shock, with tension crash and bronchospasm. The substances considered to be most responsible for the occurrence of intraoperative allergic reactions are neuromuscular blocking agents, antibiotics and latex. Recent studies have identified a new receptor, Mas-Related G-Protein-coupled Receptor X2 (MRGPRX2), considered as a target for some neuromuscular blockers such as atracurium, rocuronium or fluoroquinolone, resulting in pseudoallergic or anaphylactoid reactions. Induction of anesthesia can use both depolarizing myorelaxants, useful especially in emergency situations, in the patient with gastric plenitude or at high risk of intubation, and non-depolarizing myorelaxants such as atracurium, cisatracurium and rocuronium. Succinylcholine has a short time of action and it is rapidly metabolized. Atracurium, although having a slightly longer time to action, has the benefit of a low risk of increased levels of potassium in blood, which is extremely important in patients with cardiac pathology or associated kidney diseases. The present study compared the side effects of systemic anesthesia with succinylcholine vs. atracurium.

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Severe anaphylactic reaction to atracurium

Cited by 4 publications

References 1 publication

Drug-induced anaphylactic reactions in Indian population: A systematic review

Drug-induced anaphylactic reactions in Indian population: A systematic review

A suspected non‐allergic anaphylactic reaction to intravenous administration of atracurium in a dog

Postanesthetic skin erythema due to succinylcholine versus atracurium

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