Anaphylaxis to rocuronium

Reports about anaphylactic and anaphylactoid reactions to rocuroniumhave increased recently. We report two new cases of documentedgrade III anaphylaxis, leading to death in one patient. Thefirst case occurred in an 81-year-old ASA II woman scheduledfor emergency abdominal surgery. Severe hypotension and tachycardiawere observed after rocuronium, without bronchospasm. Neosynephrineallowed rapid resuscitation, and the patient recovered fully.The second patient was a 64-year-old ASA II man scheduled forabdominal surgery. Severe haemodynamic instability and bronchospasmoccurred after rocuronium. Despite immediate life support, thepostoperative period was complicated by persistent low systolicpressure, acute respiratory distress syndrome, acute renal failure,disseminated intravascular coagulation and pancreatitis, leadingto the death of the patient. Br J Anaesth 2002; 88: 600–2