title: Rapacuronium and the risk of bronchospasm in pediatric patients.
abstract: We conducted this study to determine the risk factors for the development of bronchospasm after the administration of rapacuronium and to determine if children with bronchospasm on induction of anesthesia were more likely to have received rapacuronium compared with other muscle relaxants. In a retrospective cohort study, all anesthetic records in which rapacuronium was administered were reviewed to determine which patients developed bronchospasm during induction of anesthesia. Two-hundred-eighty-seven patients were identified, of whom 12 (4.2%; 95% confidence interval [CI], 2.2%--7.2%) developed bronchospasm during induction of anesthesia. Significant risk factors for the development of bronchospasm with administration of rapacuronium included rapid sequence induction (relative risk [RR], 17.9; 95% CI, 2.9--infinity) and prior history of reactive airways disease (RR, 4.6; 95% CI, 1.5--14.3). In a case-control study, all cases of bronchospasm during induction of anesthesia in the 5-mo time period that rapacuronium was available for clinical use were identified. Aside from the 12 cases of bronchospasm with rapacuronium, 11 additional cases of bronchospasm were associated with the use of other muscle relaxants. Four controls were randomly selected for each of the 23 cases of bronchospasm. Children with bronchospasm during induction of anesthesia were several times more likely (odds ratio, 10.1; 95% CI, 3.5--28.8) for having received rapacuronium compared with other muscle relaxants.
  
  
  CONCLUSIONS
  In a retrospective cohort study, significant risk factors for the development of bronchospasm with the administration of rapacuronium on induction of anesthesia included rapid sequence induction and prior history of reactive airways disease. In a case-control study, children with bronchospasm during induction of anesthesia were several times more likely to have received rapacuronium compared with other muscle relaxants.
authors.affiliation: Department of Anesthesiology & Critical Care Medicine, The Children's Hospital of Philadelphia, University of Pennsylvania, Philadelphia 19104-4399, USA. rajchert@email.chop.edu
authors.forename: Donna M
authors.initials: DM
authors.lastname: Rajchert
authors.forename: Caroline A
authors.initials: CA
authors.lastname: Pasquariello
authors.forename: Mehernoor F
authors.initials: MF
authors.lastname: Watcha
authors.forename: Mark S
authors.initials: MS
authors.lastname: Schreiner
mesh_terms: D000293:Adolescent; D001986:Bronchial Spasm / Q000139:chemically induced*; D016022:Case-Control Studies; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D003473:Neuromuscular Nondepolarizing Agents / Q000009:adverse effects*; D012189:Retrospective Studies; D012307:Risk Factors; D014673:Vecuronium Bromide / Q000009:adverse effects* / Q000031:analogs & derivatives*
chemical_list: D003473:Neuromuscular Nondepolarizing Agents; D014673:Vecuronium Bromide; C082938:rapacuronium