title: Rapid pre-operative immunotherapy in a patient allergic to muscle relaxants.
abstract: Allergic reactions to muscle relaxants are not uncommon. Although, in most instances, divalent quaternary ammonium salts are involved in these reactions, some monovalent quaternary ammonium compounds can trigger IgE-mediated reactions. A woman who suffered from several episodes of anaphylaxis with divalent (suxamethonium) and monovalent quaternary ammonium salts (tiemonium) needed surgery. Regional anaesthesia was contra-indicated owing to a possible intolerance to local anaesthetics. Investigation confirmed an allergy to monovalent quaternary ammonium salts. Rapid immunotherapy was started with a monovalent quaternary ammonium salt (tiemonium) and subsequently followed by a general anaesthesia using vecuronium. The patient did not develop anaphylactic symptoms.
authors.affiliation: Départment Anesthésie Réanimation, C.H.U. Carameau, Nimes, France.
authors.forename: H
authors.initials: H
authors.lastname: Thomas
authors.forename: J J
authors.initials: JJ
authors.lastname: Eledjam
authors.forename: M
authors.initials: M
authors.lastname: Macheboeuf
authors.forename: F
authors.initials: F
authors.lastname: d'Athis
authors.forename: P
authors.initials: P
authors.lastname: Mares
authors.forename: J
authors.initials: J
authors.lastname: Bousquet
mesh_terms: D000328:Adult; D003888:Desensitization, Immunologic; D004342:Drug Hypersensitivity / Q000517:prevention & control*; D005260:Female; D006801:Humans; D009125:Muscle Relaxants, Central / Q000009:adverse effects* / Q000276:immunology; D011300:Preoperative Care; D000644:Quaternary Ammonium Compounds / Q000276:immunology
chemical_list: D009125:Muscle Relaxants, Central; D000644:Quaternary Ammonium Compounds