Atracurium-induced anaphylaxis and angioedema: a case report.
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Date
2015-07
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Abstract
Drug-induced anaphylaxis has increased in frequency with the more widespread
use of pharmaceutical agents. Neuromuscular blocking agents (NMBAs) are one of
the most common causes of anaphylaxis during general anesthesia. However, the
incidence of anaphylaxis due to atracurium is very rare (<1/10,000) according to UK
Summary of Product Characteristics. NMBAs can induce two types of reactions: one
is immune mediated - immunoglobulin E dependent and the second one is associated
with non-specific stimulation of mast cells. Systemic manifestations of anaphylaxis
can be in the form of hypotension, difficulty in breathing. Rarely, it can be associated
with cutaneous manifestations such as urticaria, angioedema, and flushing. If it is
not promptly diagnosed and treated, it can be fatal. In the present case, the patient
was posted for submandibular gland surgery. She was well-stabilized after general
anesthesia and within the seconds of giving injection atracurium; she had difficulty
in breathing and marked decrease in blood pressure that was soon followed by
periorbital swelling and swelling of lips. The patient was diagnosed with anaphylaxis
with angioedema due to atracurium and was promptly managed in operation theater.
She was kept under observation for 2 days. Anaphylaxis along with angioedema with
atracurium is a very rare event, and hence it is being reported here.
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Keywords
Anaphylaxis, Angioedema, Atracurium, Neuromuscular blocking agents
Citation
Sharma Jyoti, Verma Savita, Gupta M C. Atracurium-induced anaphylaxis and angioedema: a case report. International Journal of Basic & Clinical Pharmacology. 2015 Jul-Aug; 4(4): 802-804.