Thomas H, Eledjam J J, Macheboeuf M, d'Athis F, Mares P, Bousquet J
Départment Anesthésie Réanimation, C.H.U. Carameau, Nimes, France.
Eur J Anaesthesiol. 1988 Nov;5(6):385-9.
Allergic reactions to muscle relaxants are not uncommon. Although, in most instances, divalent quaternary ammonium salts are involved in these reactions, some monovalent quaternary ammonium compounds can trigger IgE-mediated reactions. A woman who suffered from several episodes of anaphylaxis with divalent (suxamethonium) and monovalent quaternary ammonium salts (tiemonium) needed surgery. Regional anaesthesia was contra-indicated owing to a possible intolerance to local anaesthetics. Investigation confirmed an allergy to monovalent quaternary ammonium salts. Rapid immunotherapy was started with a monovalent quaternary ammonium salt (tiemonium) and subsequently followed by a general anaesthesia using vecuronium. The patient did not develop anaphylactic symptoms.
对肌肉松弛剂的过敏反应并不罕见。虽然在大多数情况下，这些反应涉及二价季铵盐，但一些一价季铵化合物也可引发IgE介导的反应。一名患有多次二价（琥珀胆碱）和一价季铵盐（替莫铵）过敏反应的女性需要进行手术。由于可能对局部麻醉药不耐受，区域麻醉被列为禁忌。检查证实对一价季铵盐过敏。开始用一价季铵盐（替莫铵）进行快速免疫治疗，随后使用维库溴铵进行全身麻醉。患者未出现过敏症状。
