Rocuronium-bromide

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Rocuronium-bromide Anaphylaxis: case report

A 19-year-old man developed anaphylaxis following administration of rocuronium bromide for induction of anaesthesia. The man, who had no history of allergy or surgery, presented for scheduled open reduction and internal fixation for mandibular fracture. Anaesthesia was induced with propofol and rocuronium bromide 80mg [route not stated]. Continuous administration of remifentanil was started simultaneously. Immediately after the induction of anaesthesia, he exhibited skin erythema and wheals primarily in the anterior chest area. Despite successful endotracheal intubation, his oxygen saturation decreased to approximately 80%. He also developed wheezing. He did not show any cardiovascular symptoms. An allergic reaction (anaphylaxis) or an asthmatic attack was suspected. The man was treated with salbutamol and dexamethasone. Subsequently, his respiratory symptoms improved. However, the surgery was canceled, and he was transferred to the ICU. Three hours after the event, he was extubated. As the surgery was urgent, it was scheduled again 10 days after the event. Two days prior the rescheduled surgery, skin prick tests (SPTs) and intradermal tests (IDTs) using all the drugs suspected to be the possible cause of anaphylaxis were tested, and showed negative results. However, considering the possibility of false negative results, midazolam, pentazocaine, sevoflurane and nitrous oxide were used as general anaesthetics during the rescheduled surgery. The surgery was completed uneventfully. Seven weeks after the anaphylaxis episode, repeat SPTs showed negative results for propofol, remifentanil and rocuronium bromide. However, a basophil activation test with rocuronium bromide showed marked increase in activated basophils after stimulation with 10,000 µg/mL rocuronium bromide, confirming it to be the cause for the anaphylactic episode. Orihara M, et al. Interpreting the results of early skin tests after perioperative anaphylaxis requires special attention: a case report and review of literature. Journal of Anesthesia 34: 624-629, No. 4, Aug 2020. Available from: URL: http://doi.org/10.1007/s00540-020-02802-x

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Reactions 29 Aug 2020 No. 1819

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