Risk determination by cross-reactivtiy

Anaphylaxis during surgery is often linked to neuromuscular blocking agents (NMBAs), with rocuronium showing a notably higher risk compared to other drugs like vecuronium and atracurium. A study conducted in Western Australia over ten years identified 98 cases of NMBA-related anaphylaxis, with rocuronium responsible for approximately half of these incidents. Key findings include: The study used a case-control design, comparing anaphylaxis cases with controls, and employed bootstrapping for statistical analysis. These findings suggest that anesthesiologists should consider alternatives to rocuronium, especially in patients with pholcodine exposure, though the absence of universal cross-reactivity is reassuring. Limitations include potential changes in prescribing practices over time and the need for further research to establish causation between pholcodine use and NMBA-induced anaphylaxis.