Dhonneur Gilles, Combes Xavier, Chassard Didier, Merle Jean Claude
*Department of Anesthesia and Critical Care Medicine, University Hospital and Paris XII Val-de-Marne School of Medicine, Créteil, France; and †Clinical Research Organisation, CEPHAC.ASTER Institut, Paris, France.
Anesth Analg. 2004 Apr;98(4):986-989. doi: 10.1213/01.ANE.0000111206.50145.47.
Prick tests are frequently used for the authentication of neuromuscular blocking drugs (NMBDs) as causative drugs for anaphylactic reactions during anesthesia. Unfortunately, the actual threshold concentration for skin testing remains debatable for most NMBDs. We studied the flare and wheal responses to prick tests with rocuronium and vecuronium. Thirty healthy, nonatopic, anesthesia-naive male and female volunteers (14 men and 16 women) from 18 to 40 yr of age were assigned randomly to receive a total of 10 prick tests-4 ascending dilutions (1:1000, 1:100, 1:10, and 1) of rocuronium and vecuronium and 2 controls-on both forearms. An assessor blinded to the assignment monitored systemic and skin responses to NMBDs and measured wheal and flare surfaces immediately after and 15 min after prick tests. None of the volunteers experienced any immediate systemic or cutaneous responses to rocuronium or vecuronium. Although a dilution of 1:1000 of both NMBDs failed to promote any skin response at 15 min, 50% and 40% of the subjects had a positive skin reaction to undiluted rocuronium and vecuronium, respectively. We demonstrated a sex effect related to smaller threshold concentration-induced cutaneous reactions in female volunteers to both muscle relaxants. Our observation questions the reliability of prick testing with undiluted solutions of rocuronium and vecuronium for the diagnosis of allergy.
Building concentration-skin response curves to prick tests with rocuronium and vecuronium in healthy, nonatopic, anesthesia-naive male and female volunteers demonstrated that the nonreactive concentration for both muscle relaxants is the 1:1000 dilution of the stock solutions. Our observation calls into question the past practice of prick-testing skin for sensitivity to neuromuscular blocking drugs by using undiluted solutions.
皮内试验常用于鉴定神经肌肉阻滞药物（NMBDs）是否为麻醉期间过敏反应的致病药物。遗憾的是，大多数NMBDs的皮肤试验实际阈值浓度仍存在争议。我们研究了罗库溴铵和维库溴铵皮内试验引起的风团和红晕反应。30名年龄在18至40岁之间、健康、无特应性、未接受过麻醉的男女志愿者（14名男性和16名女性）被随机分配，在前臂两侧总共接受10次皮内试验，即罗库溴铵和维库溴铵的4种递增稀释液（1:1000、1:100、1:10和1）以及2种对照。一名对分组不知情的评估者监测NMBDs引起的全身和皮肤反应，并在皮内试验后立即及15分钟后测量风团和红晕面积。没有志愿者对罗库溴铵或维库溴铵出现任何即刻全身或皮肤反应。虽然两种NMBDs的1:1000稀释液在15分钟时未引起任何皮肤反应，但分别有50%和40%的受试者对未稀释的罗库溴铵和维库溴铵出现阳性皮肤反应。我们证明了一种性别效应，即女性志愿者对两种肌肉松弛剂的阈值浓度诱导的皮肤反应较小。我们的观察对用未稀释的罗库溴铵和维库溴铵溶液进行皮内试验诊断过敏的可靠性提出了质疑。
在健康、无特应性、未接受过麻醉的男女志愿者中构建罗库溴铵和维库溴铵皮内试验的浓度-皮肤反应曲线表明，两种肌肉松弛剂的无反应浓度为原液的1:1000稀释液。我们的观察对过去使用未稀释溶液进行皮内试验检测皮肤对神经肌肉阻滞药物敏感性的做法提出了质疑。
