[Anaphylactic shock induced by suxamethonium]. / Choc anaphylactique au suxaméthonium. A propos de 18 cas.

ABSTRACT

The authors have studied 18 cases of anaphylactic shock due to suxamethonium which occurred in eastern France during the period 1972-1980. The drug responsible was succinyl iodide in 15 cases and succinyl chloride in 3. Significant contributing factors were previous drug allergy, spasmophilia and skin hypersensitivity to histamine. Five subjects had never been previously anaesthetized. The predominant clinical symptoms were cardiovascular collapse (72 p. cent), cutaneous and mucous symptoms (72 p. cent) and bronchospasm (33 p. cent). Cardiac arrest was observed in 5 patients; it was postanoxic in 3 cases and primary in 2. The diagnosis of anaphylaxis was based on the simultaneous positivity of at least two of the specific immunoallergic tests intradermal reaction to a 10(-5) to 10(-3) dilution of the drug; Prausnitz-Küstner test with Parish's variant and human basophil degranulation test. If only one test was positive, this had to be confirmed on two or even three occasions. Thus, 6 patients were tested once, 9 patients were tested twice and 3 patients were tested 3 times. In case of genuine anaphylaxis, suxamethonium must definitely be avoided, and the subject should be provided with an allergy card.