Częstość występowania reakcji anafilaktycznych u 3560 chorych znieczulanych metodą TIVA z użyciem różnych środków zwiotczających mięśnie – jednoroczne badanie retrospektywne

*Grażyna Michalska-Krzanowska¹, Michał Kurek², Radosław Ratajski¹

Summary
Background. Anaphylactic reactions during anaesthesia occur with the frequency of 1:10 000 to 1:20 000. They constitute 9-19% of all anaesthetic complications. The ratio is higher (1:6 500) when neuromuscular blocking agents (NMBA) are used. According to the results of multicentre trials, the most common triggering factors of anaphylactic reactions during anaesthesia are NMBAs, responsible for 60% of such events.The aim of this study was to assess the frequency and severity of symptoms related to anaphylaxis among the whole group of patient undergoing TIVA during one year, with NMBAs, in particular.
Method. The anaesthetic records of 3560 patients (adults and children) were assessed. The following scoring scale for anaphylactic symptoms was used: I° – symptoms limited only to skin and mucosa, II° – mild symptoms limited to cardiovascular or respiratory system, III° – potentially life-threatening cardiovascular or airway symptoms, IV° – cardiac or respiratory arrest.
Results. Symptoms of anaphylaxis were recorded during 130 anaesthetic procedures with the overall frequency of 4%, when suxamethonium, rocuronium or pancuronium but not cisatracurium were used as NMBA. According to our scoring scale the results were as follows: I° – 65.4%; II° – 26.9%; III° – 6.9%; IV° – 0.8%. Although cisatracurium was the most common NMBA used, the symptoms of anaphylaxis were observed only in patients treated with suxamethonium (p<0.05), pancuronium or rocuronium.
Conclusion. Our results confirm that anaphylaxis during TIVA is strongly related to NMBA. It seems reasonable to perform further prospective epidemiological trial and to design maximally sufficient preventive programmes for minimising the risk of such complications.

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