Rocuronium‐Induced Anaphylaxis in the Perioperative Period: A Clinical Review

ABSTRACT Rocuronium, a nondepolarizing neuromuscular blocking agent used for muscle relaxation especially during endotracheal intubation, can cause hypersensitivity reactions. This article provides an overview of anaphylactic reactions; risk factors; and the pathophysiology, presentation, diagnosis,...

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Bibliographic Details
Published in:AORN journal 2024-01, Vol.119 (1), p.47-58
Main Author: Harris, David E.
Format: Article
Language:English
Subjects:
Allergens
Anaphylaxis
Anaphylaxis - diagnosis
Antibiotics
Edema
Epinephrine
Erythema
Histamine
Humans
hypersensitivity reaction
Hypotension
Immunoglobulins
Intubation
Medical research
nondepolarizing neuromuscular blocking agent (NMBA)
Pathophysiology
Patients
Risk factors
Rocuronium
sugammadex
Surgery
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Summary:ABSTRACT Rocuronium, a nondepolarizing neuromuscular blocking agent used for muscle relaxation especially during endotracheal intubation, can cause hypersensitivity reactions. This article provides an overview of anaphylactic reactions; risk factors; and the pathophysiology, presentation, diagnosis, treatment, and nursing implications associated with rocuronium‐induced anaphylaxis. Life‐threatening anaphylaxis can be immunoglobulin E–mediated or non–immunoglobulin E‐mediated and usually occurs after the first dose. Anaphylaxis can present with hypotension and bronchospasm; cutaneal symptoms, such as erythema, may not be obvious. Diagnosis is initially presumptive and may require a transesophageal echocardiogram to rule out other causes of hypotension (eg, pulmonary embolus). Emergency treatment begins with epinephrine administration and fluid boluses; cardiac support devices may be needed. Definitive diagnosis requires early measurement of histamine and tryptase levels and skin testing after the patient recovers from the reaction. Perioperative nurses should be prepared to participate in emergency treatment of anaphylaxis and advocate for testing for a definitive diagnosis.
ISSN:0001-2092
1878-0369
DOI:10.1002/aorn.14053