We have located links that may give you full text access.
Case Reports
Journal Article
[Anaphylaxis by atracurium. One case report].
Revista Alergia Mexico : Organo Oficial de la Sociedad Mexicana de Alergia e Inmunología, A.C 2013 April
BACKGROUND: The incidence of severe intraoperative anesthetic reactions varies among countries from 1:10,000 to 1:13 000 patients submitted to surgery.
CASE REPORT: A 13 year old male, with family history of atopy, who underwent 5 surgeries for hydrocephalus, using general anesthesia. He was on lamotrigine for seizures. He also suffers from chronic rhinitis, and oral allergy syndrome related to bananas since the age of 6 months. He had a posterior fossa tumor resection. During anesthesia induction with atracurium he developed a local rash in one arm, being the intubation without difficulty. Twenty minutes later he presented bipalpebral edema, accompanied by generalized rash, severe bronchoconstriction and hypotension, not reversing with the use of bronchodilators and corticosteroids. With the use of antihistamines, epinephrine and controlled ventilation the reaction subsides. One month later a skin prick test with atracurium besylate (50 mg/mL) diluted 1:10,000, negative and positive controls was performed. The result with atracurium was negative. After the application of intradermal tests with 0.02 mL of atracurium at dilutions of 1:10,000 and 1:1000, we found a positive skin response to atracurium (wheal diameter >8 mm and >9 mm with dilutions 1:10,000 and 1:1000, respectively and erythema). The response to atracurium intradermal test could be related to the ability of histamine release by a nonimmunological mechanism. But the magnitude of the skin response in this case, do not rule out the possibility of an IgE-mediated reaction. Atracurium is a known potent histamine releaser from mast cells, but rarely can it cause IgE-mediated reactions.
CASE REPORT: A 13 year old male, with family history of atopy, who underwent 5 surgeries for hydrocephalus, using general anesthesia. He was on lamotrigine for seizures. He also suffers from chronic rhinitis, and oral allergy syndrome related to bananas since the age of 6 months. He had a posterior fossa tumor resection. During anesthesia induction with atracurium he developed a local rash in one arm, being the intubation without difficulty. Twenty minutes later he presented bipalpebral edema, accompanied by generalized rash, severe bronchoconstriction and hypotension, not reversing with the use of bronchodilators and corticosteroids. With the use of antihistamines, epinephrine and controlled ventilation the reaction subsides. One month later a skin prick test with atracurium besylate (50 mg/mL) diluted 1:10,000, negative and positive controls was performed. The result with atracurium was negative. After the application of intradermal tests with 0.02 mL of atracurium at dilutions of 1:10,000 and 1:1000, we found a positive skin response to atracurium (wheal diameter >8 mm and >9 mm with dilutions 1:10,000 and 1:1000, respectively and erythema). The response to atracurium intradermal test could be related to the ability of histamine release by a nonimmunological mechanism. But the magnitude of the skin response in this case, do not rule out the possibility of an IgE-mediated reaction. Atracurium is a known potent histamine releaser from mast cells, but rarely can it cause IgE-mediated reactions.
Full text links
Related Resources
Get seemless 1-tap access through your institution/university
For the best experience, use the Read mobile app
All material on this website is protected by copyright, Copyright © 1994-2024 by WebMD LLC.
This website also contains material copyrighted by 3rd parties.
By using this service, you agree to our terms of use and privacy policy.
Your Privacy Choices
You can now claim free CME credits for this literature searchClaim now
Get seemless 1-tap access through your institution/university
For the best experience, use the Read mobile app