Abstract

Although a number of neuromuscular blockers may cause nonspecific histamine release, serious systemic reactions are anaphylactic in type and have been shown to be due to crosslinking of IgE by these bivalent molecules. Properly performed skin testing appears to be the most reliable method of detecting sensitivity to these agents, which can occur in patients who have never been exposed to them. A negative skin test appears to be reliable in predicting that an agent can be given safely; conversely, the considerable cross-reactivity demonstrated by in vitro tests is often not clinically significant. Routine skin testing to one or more agents before surgery should be investigated for cost-effectiveness in preventing systemic reactions. Systemic reactions require prompt recognition and administration of epinephrine to prevent an adverse outcome.

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