Korean J Anesthesiol.  2013 Aug;65(2):147-150. 10.4097/kjae.2013.65.2.147.

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

• Yoon Y
• Lee B
• Seo HS
• Bang J
• Ha SI
• Song JG

• KMID: 2031257
• DOI: http://doi.org/10.4097/kjae.2013.65.2.147

Abstract

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.

Keyword

Anaphylaxis; Cisatracurium; General anesthesia; Neuromuscular blocking agents

MeSH Terms

Anaphylaxis
Anesthesia, General
Anesthetics
Atracurium
Bronchial Spasm
Humans
Hypotension
Intradermal Tests
Ions
Lidocaine
Midazolam
Neuromuscular Blocking Agents
Piperidines
Propofol
Quaternary Ammonium Compounds
Skin
Anesthetics
Atracurium
Ions
Lidocaine
Midazolam
Neuromuscular Blocking Agents
Piperidines
Propofol
Quaternary Ammonium Compounds