• Br J Anaesth · May 2021

    Relationship of perioperative anaphylaxis to neuromuscular blocking agents, obesity, and pholcodine consumption: a case-control study.

    Pholcodine consumption greatly increases the risk of NMBD anaphylaxis (OR 14.0).

    pearl
    • Sadleir Paul H M PHM Department of Anaesthesia, Sir Charles Gairdner Hospital, Perth, Western Australia, Australia; Western Australian Anaesthetic Allergy Clinic, Perth, , Russell C Clarke, Catherine E Goddard, Conor Day, William Weightman, Alex Middleditch, and Peter R Platt.
    • Department of Anaesthesia, Sir Charles Gairdner Hospital, Perth, Western Australia, Australia; Western Australian Anaesthetic Allergy Clinic, Perth, Western Australia, Australia; University of Western Australia, Perth, Western Australia, Australia. Electronic address: paulsadleir@hotmail.com.
    • Br J Anaesth. 2021 May 1; 126 (5): 940-948.

    BackgroundThe observation that patients presenting for bariatric surgery had a high incidence of neuromuscular blocking agent (NMBA) anaphylaxis prompted this restricted case-control study to test the hypothesis that obesity is a risk factor for NMBA anaphylaxis, independent of differences in pholcodine consumption.MethodsWe compared 145 patients diagnosed with intraoperative NMBA anaphylaxis in Western Australia between 2012 and 2020 with 61 patients with cefazolin anaphylaxis with respect to BMI grade, history of pholcodine consumption, sex, age, comorbid disease, and NMBA type and dose. Confounding was assessed by stratification and binomial logistic regression.ResultsObesity (odds ratio [OR]=2.96, χ2=11.7, P=0.001), 'definite' pholcodine consumption (OR=14.0, χ2=2.6, P<0.001), and female sex (OR=2.70, χ2=9.61, P=0.002) were statistically significant risk factors for NMBA anaphylaxis on univariate analysis. The risk of NMBA anaphylaxis increased with BMI grade. Confounding analysis indicated that both obesity and pholcodine consumption remained important risk factors after correction for confounding, but that sex did not. The relative rate of rocuronium anaphylaxis was estimated to be 3.0 times that of vecuronium using controls as an estimate of market share, and the risk of NMBA anaphylaxis in patients presenting for bariatric surgery was 8.8 times the expected rate (74.9 vs 8.5 per 100 000 anaesthetic procedures).ConclusionsObesity is a risk factor for NMBA anaphylaxis, the risk increasing with BMI grade. Pholcodine consumption is also a risk factor, and this is consistent with the pholcodine hypothesis. Rocuronium use is associated with an increased risk of anaphylaxis compared with vecuronium in this population.Crown Copyright © 2020. Published by Elsevier Ltd. All rights reserved.

      Pubmed     Full text   Copy Citation     Plaintext  

      Add institutional full text...

    This article appears in the collection: What is the significance of Pholcodine for anesthesia?.

    Notes

    pearl
    1

    Pholcodine consumption greatly increases the risk of NMBD anaphylaxis (OR 14.0).

    Daniel Jolley  Daniel Jolley
    pearl
    1

    Obesity increases the risk of NMBD anaphylaxis (OR 2.96).

    Daniel Jolley  Daniel Jolley
     
    Knowledge, pearl, summary or comment to share?
    300 characters remaining
    help        
    You can also include formatting, links, images and footnotes in your notes
    • Simple formatting can be added to notes, such as *italics*, _underline_ or **bold**.
    • Superscript can be denoted by <sup>text</sup> and subscript <sub>text</sub>.
    • Numbered or bulleted lists can be created using either numbered lines 1. 2. 3., hyphens - or asterisks *.
    • Links can be included with: [my link to pubmed](http://pubmed.com)
    • Images can be included with: ![alt text](https://bestmedicaljournal.com/study_graph.jpg "Image Title Text")
    • For footnotes use [^1](This is a footnote.) inline.
    • Or use an inline reference [^1] to refer to a longer footnote elseweher in the document [^1]: This is a long footnote..

    hide…