Department of Anaesthesia, Sir Charles Gairdner Hospital, Perth, Western Australia, Australia; Western Australian Anaesthetic Allergy Clinic, Perth, Western Australia, Australia; University of Western Australia, Perth, Western Australia, Australia.
Department of Anaesthesia, Sir Charles Gairdner Hospital, Perth, Western Australia, Australia; Western Australian Anaesthetic Allergy Clinic, Perth, Western Australia, Australia.
Br J Anaesth. 2021 May;126(5):940-948. doi: 10.1016/j.bja.2020.12.018. Epub 2021 Jan 14.
The observation that patients presenting for bariatric surgery had a high incidence of neuromuscular blocking agent (NMBA) anaphylaxis prompted this restricted case-control study to test the hypothesis that obesity is a risk factor for NMBA anaphylaxis, independent of differences in pholcodine consumption.
We compared 145 patients diagnosed with intraoperative NMBA anaphylaxis in Western Australia between 2012 and 2020 with 61 patients with cefazolin anaphylaxis with respect to BMI grade, history of pholcodine consumption, sex, age, comorbid disease, and NMBA type and dose. Confounding was assessed by stratification and binomial logistic regression.
Obesity (odds ratio [OR]=2.96, χ=11.7, P=0.001), 'definite' pholcodine consumption (OR=14.0, χ=2.6, P<0.001), and female sex (OR=2.70, χ=9.61, P=0.002) were statistically significant risk factors for NMBA anaphylaxis on univariate analysis. The risk of NMBA anaphylaxis increased with BMI grade. Confounding analysis indicated that both obesity and pholcodine consumption remained important risk factors after correction for confounding, but that sex did not. The relative rate of rocuronium anaphylaxis was estimated to be 3.0 times that of vecuronium using controls as an estimate of market share, and the risk of NMBA anaphylaxis in patients presenting for bariatric surgery was 8.8 times the expected rate (74.9 vs 8.5 per 100 000 anaesthetic procedures).
Obesity is a risk factor for NMBA anaphylaxis, the risk increasing with BMI grade. Pholcodine consumption is also a risk factor, and this is consistent with the pholcodine hypothesis. Rocuronium use is associated with an increased risk of anaphylaxis compared with vecuronium in this population.
接受减重手术的患者出现神经肌肉阻滞剂（NMBA）过敏反应的发生率较高，这促使进行了这项受限的病例对照研究，以检验肥胖是 NMBA 过敏反应的一个风险因素的假说，这与福可定的使用无关。
我们比较了 2012 年至 2020 年期间在西澳大利亚州诊断为术中 NMBA 过敏反应的 145 例患者和 61 例头孢唑林过敏反应患者的 BMI 分级、福可定使用史、性别、年龄、合并症和 NMBA 类型和剂量。通过分层和二项逻辑回归评估混杂因素。
肥胖（比值比 [OR]=2.96，χ=11.7，P=0.001）、“明确”福可定使用（OR=14.0，χ=2.6，P<0.001）和女性（OR=2.70，χ=9.61，P=0.002）在单变量分析中是 NMBA 过敏反应的统计学显著风险因素。随着 BMI 分级的增加，NMBA 过敏反应的风险增加。混杂分析表明，在纠正混杂因素后，肥胖和福可定使用仍然是重要的风险因素，但性别不是。使用对照作为市场份额的估计，罗库溴铵过敏反应的相对发生率估计为维库溴铵的 3.0 倍，而接受减重手术的患者 NMBA 过敏反应的风险是预期发生率的 8.8 倍（74.9 比每 100000 次麻醉手术 8.5）。
肥胖是 NMBA 过敏反应的一个风险因素，风险随 BMI 分级增加而增加。福可定的使用也是一个风险因素，这与福可定假说一致。与维库溴铵相比，在该人群中使用罗库溴铵与过敏反应的风险增加相关。
