Peri‐operative hypersensitivity reactions to neuromuscular blocking drugs in New Zealand 2013–2019: a retrospective observational study
Year: 2025
Type: article
Study design: Observational Study
Abstract: INTRODUCTION: Peri-operative hypersensitivity reactions are rare and unpredictable events that can result in significant patient harm. Neuromuscular blocking drugs are one of the leading causes of peri-operative hypersensitivity reactions in many parts of the world. METHODS: Our retrospective observational cohort study of in adults in New Zealand investigated the incidence and relative risk of a peri-operative hypersensitivity reaction to the various to neuromuscular blocking drugs. We also explored possible cross-sensitivity between the different neuromuscular blocking drugs using skin testing. The incidence of anaphylaxis to neuromuscular blocking drugs was calculated within a subset of our cohort, using confirmed cases of anaphylaxis to each neuromuscular blocking drug as the numerator and number of new patient exposures to the drug as the denominator. RESULTS: We determined the risk of a peri-operative hypersensitivity reaction with individual neuromuscular blocking drugs to be: suxamethonium 1:1500 (95%CI 1000-2500); rocuronium 1:3300 (95%CI 2100-5300); and atracurium 1:15,000 (95%CI 6800-40,000). Female patients were up to eight times more likely to experience a peri-operative hypersensitivity reaction than males. Our skin test results suggest that if a patient experiences a peri-operative hypersensitivity reaction to rocuronium, suxamethonium or vecuronium, then atracurium is the lowest risk alternative. If a patient has had a peri-operative hypersensitivity reaction to atracurium, then rocuronium and suxamethonium are low risk alternatives. DISCUSSION: We found a significant difference between the rates of peri-operative hypersensitivity reactions with rocuronium and suxamethonium vs. atracurium. The increased risk of a peri-operative hypersensitivity reaction is a factor that should be weighed against the benefits of using suxamethonium or rocuronium. Females may be higher risk than males of reacting to neuromuscular blocking drugs.
Source: Anaesthesia
DOI: 10.1111/anae.70058
Authors: Karen Pedersen, Johan van Schalkwyk, Kim Phillips, Henry Wang, Peter Cooke
Institution: Health New Zealand
Language: English
Subfield: Pharmacology
Field: Medicine
Domain: Health Sciences
Open Access status: bronze
OpenAlex ID: W4416065539