Document Detail


Skin reactions to intradermal neuromuscular blocking agent injections: a randomized multicenter trial in healthy volunteers.
MedLine Citation:
PMID:  17667568     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: Numerous reports confirm the performance of intradermal tests for the diagnosis of anaphylaxis during anesthesia; however, there is controversy over their diagnostic value regarding the newer neuromuscular blocking agents (NMBAs). METHODS: One hundred eleven healthy volunteers were randomly assigned to receive intradermal injections of two NMBAs, at five increasing concentrations. A concentration was considered as a reactive concentration when it led to a positive reaction in more than 5% of the subjects. These concentrations were compared with the maximal concentration recommended for the diagnosis of sensitization to NMBAs. RESULTS: The maximal nonreactive concentrations were 10 m for suxamethonium; 10 m for pancuronium, vecuronium, rocuronium, and cisatracurium; and 10 m for atracurium and mivacurium. Except for mivacurium, these nonreactive concentrations were close to the maximal concentrations used for the diagnosis of sensitization against NMBAs. For mivacurium, the nonreactive concentrations were higher than the maximal concentration currently recommended in clinical practice. CONCLUSION: The aminosteroidal NMBAs pancuronium, vecuronium, and rocuronium and the benzylisoquinoline cisatracurium have a similar potency to induce a nonspecific skin reactivity. If the criteria for positivity and the maximal concentrations of the commercially available compounds recommended by French practice guidelines are used, the risk of false-positive results is limited, and only minor modifications of these recommendations could be suggested. A slight reduction in the maximal concentration used for rocuronium from 1:100 to 1:200 and an increase from 1:1,000 to 1:200 for mivacurium can be proposed.
Authors:
Paul Michel Mertes; Denise Anne Moneret-Vautrin; Francisque Leynadier; Marie-Claire Laxenaire
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Publication Detail:
Type:  Journal Article; Multicenter Study; Randomized Controlled Trial    
Journal Detail:
Title:  Anesthesiology     Volume:  107     ISSN:  0003-3022     ISO Abbreviation:  Anesthesiology     Publication Date:  2007 Aug 
Date Detail:
Created Date:  2007-08-01     Completed Date:  2007-09-21     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  1300217     Medline TA:  Anesthesiology     Country:  United States    
Other Details:
Languages:  eng     Pagination:  245-52     Citation Subset:  AIM; IM    
Affiliation:
Department of Anesthesiology, Service d'Anesthésie-Réanimation, Hôpital Central, Centre Hospitalier Universitaire de Nancy, Unité Inserm 684, Faculté de Médecine de Nancy, France. pm.mertes@chu-nancy.fr
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MeSH Terms
Descriptor/Qualifier:
Adolescent
Adult
Androstanols / administration & dosage,  adverse effects
Atracurium / administration & dosage,  adverse effects,  analogs & derivatives
Dose-Response Relationship, Drug
Drug Hypersensitivity / diagnosis*
Female
Humans
Injections, Intradermal
Isoquinolines / administration & dosage,  adverse effects
Male
Middle Aged
Neuromuscular Blocking Agents / administration & dosage*,  adverse effects*
Neuromuscular Depolarizing Agents / administration & dosage,  adverse effects
Neuromuscular Nondepolarizing Agents / administration & dosage,  adverse effects
Pancuronium / administration & dosage,  adverse effects
Reference Values
Skin / drug effects*
Skin Tests / methods
Succinylcholine / administration & dosage,  adverse effects
Vecuronium Bromide / administration & dosage,  adverse effects
Chemical
Reg. No./Substance:
0/Androstanols; 0/Isoquinolines; 0/Neuromuscular Blocking Agents; 0/Neuromuscular Depolarizing Agents; 0/Neuromuscular Nondepolarizing Agents; 0/Pancuronium; 0/cisatracurium; 106791-40-6/mivacurium; 143558-00-3/rocuronium; 306-40-1/Succinylcholine; 50700-72-6/Vecuronium Bromide; 64228-79-1/Atracurium

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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