TOPLINE:

Perioperative anaphylaxis due to neuromuscular blocking agents occurred in roughly 58 per 100,000 administrations, with nearly 20% of cases associated with morbidity. Most patients recovered fully, and the effect on future procedures requiring anesthesia was minimal as these can usually be performed without neuromuscular blocking agents, researchers said.

METHODOLOGY:

• Researchers conducted a retrospective study at a hospital in France from 2012 to 2022 and analyzed data collected from a registry-like data warehouse focusing on cases of anaphylaxis.
• They included adults who received neuromuscular blocking agents during general anesthesia and experienced anaphylaxis of grade 2, 3, or 4.
• The diagnosis of perioperative anaphylaxis was based on a short delay between the administration of agents and the onset of symptoms, with no other causes. Two groups of patients were identified: those with anaphylaxis confirmed by an allergist and suspected cases based on clinical scoring.
• A total of 158,021 procedures involving neuromuscular blocking agents, such as rocuronium, suxamethonium, mivacurium, atracurium, cisatracurium, and vecuronium, were reviewed. Among those, 94 cases of perioperative anaphylaxis (mean age, 56 years; 52.1% men; 41.1% with obesity) were identified.
• Morbidity and mortality were assessed at two intervals post-anaphylaxis: from 24 hours to 30 days and from 31 to 90 days, along with the effect on the management of future surgeries requiring anesthesia.

TAKEAWAY:

• The incidence of perioperative anaphylaxis related to neuromuscular blocking agents was 58.1 reactions per 100,000 administrations. Of those, 14.9% of cases of anaphylaxis were reported to a pharmacovigilance center.
• Surgical procedures were interrupted in 60.6% of cases due to anaphylaxis, with a median rescheduling interval of 126 days. Four patients (age, 56-75 years) died within 90 days of experiencing anaphylaxis.
• Morbidity occurred in 19 (20.2%) patients at 30 days, with renal and cardiovascular complications being the most common; 12 of the 19 patients made a full recovery, according to the researchers.
• Overall, 97 subsequent anesthesia procedures were performed; in 96 procedures, surgery was completed without the use of neuromuscular blocking agents and surgical difficulty was reported in one case.

IN PRACTICE:

“We reconfirmed that the incidence of anaphylaxis is underestimated and underreported. Most survivors of postoperative anaphylaxis recover without lasting effects. The impact on subsequent procedures requiring anesthesia is limited, as procedures can typically be performed without” neuromuscular blocking agents, the researchers reported.

SOURCE:

The study was led by Pierre d’Heudiéres, of the Department of Anaesthesiology and Critical Care at Lille University Hospital in Lille, France. It was published online on September 29, 2025, in the British Journal of Anaesthesia.

LIMITATIONS:

The study was conducted at a single center. The retrospective nature of the analysis could lead to incomplete data, especially for therapies not systematically recorded. Excluding patients who were not treated with epinephrine or norepinephrine may have underestimated the incidence of anaphylaxis.

DISCLOSURES:

No funding information was provided. One author reported receiving speaker fees from Grünenthal and benefits from Fisher & Paykel Healthcare for participation in meetings.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.