title: Adverse effects of neuromuscular blocking agents based on yellow card reporting in the U.K.: are there differences between males and females?
abstract: BACKGROUND
  Adverse drug reactions (ADRs) are known to occur during anaesthesia; in the U.K. such ADRs may be reported through the Yellow Card Scheme (YCS). Our aim was to determine the demographics of ADRs to neuromuscular blocking drugs without formal causality assessment.
  
  
  METHODS
  A retrospective analysis of ADRs to seven neuromuscular blocking drugs reported via the YCS during a greater than 30-year period was performed. Sex and age were analysed in order to identify at risk groups.
  
  
  RESULTS
  Of 998 reports, 969 included gender. Non-allergic suspected reactions occurred with almost the same frequency as those with an allergic component. The majority occurred in females 676 (70%), and significant sex differences were measured between drugs. Males were more likely to have suffered an ADR to atracurium (p = 0.01) whilst females experienced more ADRs to suxamethonium (p = 0.01). ADRs proved fatal in 81 (9%) of the 950 reports for single drugs. Mortality following suxamethonium was significantly higher in males at 22% compared with 9% females (p < 0.001). More women than men were reported to have allergic reactions, 73% (362/499) compared with 27% (137/499) respectively. The female:male ratio for ADRs was reversed for subjects < 10 years compared with peak ADR reports during the decade from 31-40 years.
  
  
  CONCLUSIONS
  Sex differences in mortality exist in this analysis. The unexpected high frequency of non-allergic ADRs suggests that morbidity and mortality from reactions to established drugs is twice that expected from allergic reactions alone. Standards and guidance for the reporting of ADRs warrant urgent development.
authors.affiliation: Magill Department of Anaesthesia, Chelsea and Westminster Hospital, London, UK.
authors.forename: Karen Patricia
authors.initials: KP
authors.lastname: Light
authors.forename: Anthony Timothy
authors.initials: AT
authors.lastname: Lovell
authors.forename: Hisham
authors.initials: H
authors.lastname: Butt
authors.forename: Nicholas John
authors.initials: NJ
authors.lastname: Fauvel
authors.forename: Anita
authors.initials: A
authors.lastname: Holdcroft
mesh_terms: D000293:Adolescent; D000328:Adult; D016907:Adverse Drug Reaction Reporting Systems; D017677:Age Distribution; D000368:Aged; D000369:Aged, 80 and over; D000707:Anaphylaxis / Q000139:chemically induced* / Q000453:epidemiology; D001279:Atracurium / Q000009:adverse effects; D002648:Child; D002675:Child, Preschool; D004342:Drug Hypersensitivity / Q000453:epidemiology; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D008875:Middle Aged; D009026:Mortality; D009467:Neuromuscular Depolarizing Agents / Q000009:adverse effects*; D003473:Neuromuscular Nondepolarizing Agents / Q000009:adverse effects*; D010197:Pancuronium / Q000009:adverse effects; D017891:Pharmacoepidemiology; D018570:Risk Assessment; D012307:Risk Factors; D017678:Sex Distribution; D013390:Succinylcholine / Q000009:adverse effects; D006113:United Kingdom / Q000453:epidemiology; D014673:Vecuronium Bromide / Q000009:adverse effects
chemical_list: D009467:Neuromuscular Depolarizing Agents; D003473:Neuromuscular Nondepolarizing Agents; D001279:Atracurium; D014673:Vecuronium Bromide; D013390:Succinylcholine; D010197:Pancuronium