rocuronium and Adenocarcinoma

We report a grade III allergic hypersensitivity reaction occurring in a 72-year-old patient immediately after anaesthesia induction. Anaphylaxis to cisatracurium was diagnosed on clinical symptoms, biological tests and positivity of the cutaneous tests to this neuromuscular blocking agent. Five days after this allergological assessment, rocuronium, a muscle relaxant for which skin tests appeared negative was used during surgery without adverse effects. The authors underline the value of a detailed allergological assessment to identify the pathophysiologic mechanism, the culprit drug and to propose a safer alternate drug that might be used.

Topics: Adenocarcinoma; Aged; Anaphylaxis; Androstanols; Atracurium; Bronchial Spasm; Drug Hypersensitivity; Humans; Intraoperative Complications; Male; Neuromuscular Nondepolarizing Agents; Rectal Neoplasms; Rocuronium; Sigmoid Neoplasms; Skin Tests

A 68-year-old man was scheduled for pancreaticoduodenectomy under general anesthesia. He was suffering from Charcot-Marie-Tooth disease (CMTD) for 34 years, and complicated with liver cirrhosis. Anesthesia was induced with propofol and fentanyl, and maintained with oxygen-air-sevoflurane and remifentanil. Epidural block was not used because the patient had coagulation abnormality and thrombocytopia. Rocuronium was injected intravenously for tracheal intubation, supplemented as required using an electrical nerve stimulator. The longer duration of action of rocuronium was observed in this case because the patient was complicated with CMTD and liver cirrhosis. We suggest that monitoring neuromuscular function may be necessary to detect subtle residual neuromuscular blockade when rocuronium is used in a patient with CMTD and liver dysfunction.

Topics: Adenocarcinoma; Aged; Androstanols; Anesthesia, General; Charcot-Marie-Tooth Disease; Duodenal Neoplasms; Humans; Liver Cirrhosis; Male; Monitoring, Intraoperative; Neuromuscular Blockade; Pancreaticoduodenectomy; Rocuronium