Fatal anaphylaxis with neuromuscular blocking agents: a risk factor and management analysis

摘要: Background Anaphylactic reactions to neuromuscular blocking agents (NMBAs) can be severe and even fatal. Our aim was evaluate mortality rate in France from anaphylactic NMBAs, identify risk factors for a fatal outcome, describe management of the cases that proved fatal. Methods The French National Pharmacovigilance Database queried reports NMBA anaphylaxis occurred between January 2000 December 2011. A questionnaire sent regional pharmacovigilance centers obtain further information on with outcome. Results Two thousand twenty-two hypersensitivity were retrieved, which 84 (4.1%). Among 1247 (grades 3 4), independent associated outcome multivariate analysis male gender (female gender: OR = 0.4; 95% CI 0.2–0.7; P = 0.0004), an emergency setting (OR = 2.6; 1.5–4.6; P = 0.0007), history hypertension (OR = 2.5; 1.5–4.4; P = 0.0010) or other cardiovascular disease (OR = 4.4; 2.4–8.1; P < 0.0001), obesity (OR = 2.4; 1.1–5.3; P = 0.0376), ongoing beta-blocker treatment (OR = 4.2; 1.8–9.8; P = 0.0011). All 31 patients received epinephrine titrated manner according international guidelines. Conclusion Obese males receiving undergoing surgery at high after NMBA-induced anaphylaxis. Some epinephrine-resistant may play role our rate. New therapeutic approaches need developed treat these cases.