An asthmatic patient developed intense bronchospasm immediately following the administration of alcuronium and d-tubocurarine in the same anaesthetic. Intradermal test was positive for both of these drugs but negative for thiopentone and suxamethonium, both of which were given prior to alcuronium. The differential diagnosis and the possible mechanism of the reaction are discussed.
References
1.
AlamM., AnrepG. V., BarsoumG. S., TalaatM., and WieningerE. (1939): “Liberation of histamine from the skeletal muscle by curare”,J. Physiol. (Lond.), 95, 148.
2.
AndertonJ. M., and HoptonD. S. (1968): “Thiopentone anaphylaxis: a hazard of multiple cystoscopic examinations under general anaesthesia”, Anaesthesia, 23, 90.
3.
Bele-BindaN., and ValeriF. (1971): “A case of bronchospasm induced by succinylcholine”, Canad. Anaesth. Soc. J., 18, 116.
4.
BucklandR. W., and AveryR. F. (1973): “Bronchospasm following pancuronium”, Brit. J. Anaesth., 45, 518.
5.
ChanC. S., and YeungM. L. (1972): “Anaphylactic reaction to alcuronium”, Brit. J. Anaesth., 44, 103.
6.
ChungD. C. W. (1976): “Anaphylaxis to thiopentone: a case report”, Canad. Anaesth. Soc. J., 23, 319.
7.
ClarkeR. M. (1973): “Reaction to pancuronium?”, Brit. J. Anaesth., 45, 997.
8.
ComroeJ. H., and DrippsR. D. (1946): “The histamine-like action of curare and tubocurarine injected intracutaneously and intra-arterially in man”, Anesthesiology, 7, 260.
9.
DundeeJ. W. (1971): “Barbiturates: clinical use” in General Anaesthesia, 3rd Edition, Vol. 1, p. 503, Ed. by GrayT. C., and NunnJ. F., Butterworths, London.
10.
EustaceB. R. (1967): “Case report: suxamethonium-induced bronchospasm”, Anaesthesia, 22, 638.
11.
FisherM. McD. (1976): “Intradermal testing after severe histamine reactions to intravenous drugs used in anaesthesia”, Anaesth. Intens. Care, 4, 97.
12.
FisherM. McD. (1978): “Anaphylactic reactions to gallamine triethiodide”, Anaesth. Intens. Care, 6, 62.
13.
FisherM. McD., HallowesR. C., and WilsonR. M. (1978): “Anaphylaxis to alcuronium”, Anaesth. Intens. Care, 6, 125.
14.
GrayT. C. (1971): “Pharmacology of clinically used relaxant drugs” in General Anaesthesia, 3rd Edition, Vol. 1, p. 586, Ed. by GrayT. C., and NunnJ. F., Butterworths, London.
15.
HeathM. L. (1973): “Bronchospasm in an asthmatic patient following pancuronium”, Anaesthesia, 28, 437.
16.
HowellJ. B. L. (1975): “Asthma: acute reversible airway obstruction” in Textbook of Medicine, 14th Edition, p. 825, Ed. by BeesonP. B., and McDermottW., Saunders, Philadelphia, London. Toronto.
17.
KatzA. M., and MulliganP. G. (1972): “Bronchospasm induced by suxamethonium”, Brit. J. Anaesth., 44, 1097.
18.
LandmesserC. M. (1947): “A study of the bronchoconstrictor and hypotensive actions of curarizing drugs”, Anesthesiology, 8, 506.
19.
LeeJ. A., and AtkinsonR. S. (1975): A Synopsis of Anaesthesia,7th Edition, p. 250, John Wright & Sons Ltd., Bristol.
20.
RowleyR. W. (1975): “Hypersensitivity reaction to diallyl nor-toxiferine (Alloferin)”, (Abstract), Anaesth. Intens. Care, 3, 74.
21.
SalemM. R., KimY., and El EtrA. A. (1968): “Histamine release following intravenous injection of d-tubocurarine”, Anesthesiology, 29, 380.
22.
SniperW. (1952): “The estimation and comparison of histamine release by muscle relaxants in man”, Brit. J. Anaesth., 24, 232.
23.
WaserP. G., and HarbeckP. (1962): “Pharmakologie und klinische Anwendung des kurzdauernden Muskelrelaxans Diallylnortoxiferine”, Anaesthesist, 11, 33.
24.
WatkinsJ., ClarkA., AppleyardT. N., and PadfieldA. (1976): “Immune-mediated reactions to Althesin (alphaxalone)”, Brit. J. Anaesth., 48, 881.
25.
WattH. K. (1973): “Anaphylactic shock from gallamine”, N.Z. Soc. Anaesth. Newsletter, 20, 21.
