title: Intraoperative anaphylaxis to neuromuscular blocking agents: the incidence over 9 years at two tertiary hospitals in South Korea: A retrospective observational study.
abstract: BACKGROUND
  Intraoperative anaphylaxis to neuromuscular blocking agents (NMBAs) is a rare event that is unpredictable and potentially life threatening. Most of the previous reports on such intraoperative anaphylaxis used market share surveys or self-reported data to estimate the incidence.
  
  
  OBJECTIVE
  To determine the incidences of intraoperative anaphylaxis to NMBAs using electronic medical records.
  
  
  METHODS
  A retrospective observational study.
  
  
  METHODS
  Two tertiary hospitals in South Korea.
  
  
  METHODS
  This study involved patients exposed to NMBAs during anaesthesia between 1 January 2005 and 31 May 2014. Nineteen episodes were deemed to be intraoperative anaphylaxis to NMBAs.
  
  
  METHODS
  We calculated the incidences of intraoperative anaphylaxis to NMBAs. Exposure to the agents was determined from intraoperative records maintained in an electronic medical recording system. An anaphylactic reaction was determined from both clinical signs and the results of skin tests.
  
  
  RESULTS
  Over 9 years, 729 429 patients were exposed to NMBA, the most frequently used being rocuronium [425 047 (58.3%)] and vecuronium [274 801 (37.7%)]. The overall incidence of intraoperative anaphylaxis was 2.6 per 100 000 (19 cases), and was higher with rocuronium (16 cases, 3.8 per 100 000) than with vecuronium (two cases, 0.7 cases per 100 000), P = 0.014. Comparing the first 3 years with the last 6 years, the incidence of intraoperative rocuronium anaphylaxis appeared to increase 1.4-fold (P = 0.006).
  
  
  CONCLUSIONS
  Among commonly used NMBAs, rocuronium appears to have the highest incidence of anaphylaxis. Our findings suggest that future prospective investigation for NMBA-induced anaphylaxis should use internationally agreed skin test protocols.
authors.affiliation: From the Department of Anaesthesiology and Pain Medicine, Seoul National University Hospital (YJC, JWJ, DMH, TKK, YJ); Department of Anaesthesiology and Pain Medicine, Samsung Medical Centre, Sungkyunkwan University School of Medicine (HS, J-HL, JJM); and Department of Internal Medicine, Seoul National University College of Medicine, Seoul, South Korea (W-JS, H-RK, S-HC).
authors.forename: Youn J
authors.initials: YJ
authors.lastname: Cho
authors.forename: Jae W
authors.initials: JW
authors.lastname: Ju
authors.forename: Hyunyee
authors.initials: H
authors.lastname: Sim
authors.forename: Jong-Hwan
authors.initials: JH
authors.lastname: Lee
authors.forename: Deok M
authors.initials: DM
authors.lastname: Hong
authors.forename: Tae K
authors.initials: TK
authors.lastname: Kim
authors.forename: Jeong Jin
authors.initials: JJ
authors.lastname: Min
authors.forename: Woo-Jung
authors.initials: WJ
authors.lastname: Song
authors.forename: Hye-Ryun
authors.initials: HR
authors.lastname: Kang
authors.forename: Sang-Heon
authors.initials: SH
authors.lastname: Cho
authors.forename: Yunseok
authors.initials: Y
authors.lastname: Jeon
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000707:Anaphylaxis / Q000139:chemically induced* / Q000175:diagnosis / Q000453:epidemiology*; D000732:Androstanols / Q000009:adverse effects*; D057286:Electronic Health Records; D005260:Female; D006801:Humans; D015994:Incidence; D007430:Intraoperative Care / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D019148:Neuromuscular Blockade / Q000009:adverse effects*; D003473:Neuromuscular Nondepolarizing Agents / Q000009:adverse effects*; D056910:Republic of Korea / Q000453:epidemiology; D012189:Retrospective Studies; D012307:Risk Factors; D000077123:Rocuronium; D012882:Skin Tests; D062606:Tertiary Care Centers; D013997:Time Factors; D014673:Vecuronium Bromide / Q000009:adverse effects
chemical_list: D000732:Androstanols; D003473:Neuromuscular Nondepolarizing Agents; D014673:Vecuronium Bromide; D000077123:Rocuronium