Adverse reactions to suxamethonium and other muscle relaxants under general anesthesia

Journal Article · Wed Jun 01 00:00:00 EDT 1983 · J. Allergy Clin. Immunol.; (United States)

DOI:https://doi.org/10.1016/0091-6749(83)90436-0· OSTI ID:5589794

Vervloet, D; Nizankowska, E; Arnaud, A; Senft, M; Alazia, M; Charpin, J

The mechanisms of anaphylactic reactions to muscle relaxants under general anesthesia are not completely understood. Extending an earlier study, we report 41 cases of anaphylactic shock investigated by intradermal skin tests with muscle relaxants (suxamethonium, pancuronium, gallamine, nortoxiferine), in vitro leukocyte histamine release, and Prausnitz-Kuestner tests. Intradermal tests were significantly positive at concentrations ranging from 10 to 10(5) times less than those in controls. Reproducibility tested for suxamethonium at a 1-year interval in five patients was good. Histamine release induced by muscle relaxants in Tris-albumin-Ca++-Mg++ buffer showed positive results in 8/25 instances and was inhibited by antigen excess in seven cases. Addition of 50% deuterium oxide (D2O) caused significant increase of histamine release in positive cases and induced release in all five negative cases studied. Muscle relaxant-induced histamine release was inhibited by in vitro anti-IgE leukocyte desensitization. The mean maximal histamine release dropped from 58.2% +/- 9.7 to 5.8% +/- 2 (p less than 0.01). Similarly, leukocyte desensitization also inhibited histamine release induced by anti-IgE but not by formyl-L-methionyl-L-leucyl-L-phenylalanine or poly-L-arginine. Prausnitz-Kuestner tests were positive in five out of 21 cases studied and became negative after heat inactivation. These results confirm the usefulness of intradermal skin tests in diagnosis of patients' reaction to muscle relaxants and suggest an IgE-mediated rather than an idiosyncratic mechanism.

• Research Organization: Department of Chest Diseases, Hopital Sainte-Marguerite, INSERM U. 174, Marseille, France
• OSTI ID: 5589794
• Journal Information: J. Allergy Clin. Immunol.; (United States), Vol. 71:6
• Country of Publication: United States
• Language: English

Related Subjects

62 RADIOLOGY AND NUCLEAR MEDICINE
ANESTHESIA
ANAPHYLAXIS
DRUGS
SIDE EFFECTS
HEAVY WATER
BIOLOGICAL EFFECTS
HISTAMINE
IMMUNE REACTIONS
SUBCUTANEOUS INJECTION
AMINES
AZOLES
HETEROCYCLIC COMPOUNDS
HYDROGEN COMPOUNDS
IMIDAZOLES
INJECTION
INTAKE
ORGANIC COMPOUNDS
ORGANIC NITROGEN COMPOUNDS
OXYGEN COMPOUNDS
WATER
550600* - Medicine