Anaphylactic reaction cases induced by neuromuscular blocking agents (NMBAs) used in surgery

Marantuan, Randolph Serep and Hendrika, Wendy (2022) Anaphylactic reaction cases induced by neuromuscular blocking agents (NMBAs) used in surgery. International Journal of Medical and Health Research, 8 (1). pp. 82-89. ISSN 2454 9142

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Abstract

Anaphylactic reactions to neuromuscular blocking agents (NMBAs) can be severe and fatal. Two thousand and twenty-two cases of NMBAs hypersensitivity were retrieved, of which 84 were fatal (4.1%). Among the 1247 cases of severe NMBAs anaphylaxis (grades 3 and 4), independent risk factors associated with a fatal outcome in a multivariate analysis were male gender, an emergency setting, a history of hypertension or other cardiovascular diseases, obesity, and ongoing beta-blocker treatment. According to international guidelines, all 31 patients with a fatal outcome received epinephrine in a titrated manner. Obese males with a history of cardiovascular disease receiving ongoing beta-blocker treatment and undergoing surgery in an emergency setting were at high risk of a fatal outcome after NMBA-induced anaphylaxis. Some epinephrine-resistant cases may play a role in our high mortality rate. New therapeutic approaches need to be developed to treat these cases. Anaphylactic shock is an issue of great concern to anesthesiologists. It is defined as a severe, life-threatening, generalized, or systemic immediate hypersensitivity reaction. Hypersensitivity reactions that occur at anaesthesia induction tend to be immune allergic reactions, and in France, they are most commonly caused by neuromuscular blocking agents (NMBAs). Epinephrine is the recommended first-line treatment, although epinephrine-resistant shock does also occur. Despite several surveys of perioperative allergic reactions, mortality from NMBAs anaphylaxis remains poorly evaluated, and its risk factors have yet to be established.

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