Background

Skin testing (ST) concentrations of neuromuscular blocking agents (NMBAs), NMBA-reversal agents, and the sugammadex-rocuronium inclusion complex (S-R-Cx) vary widely among reports.

Objective

To determine maximal ST nonirritant concentrations (NICs) of NMBAs (cisatracurium, rocuronium, succinylcholine, and vecuronium), NMBA-reversal agents (neostigmine and sugammadex), and S-R-Cx in NMBA-tolerant and NMBA-naïve participants.

Methods

A single-center, prospective study between October 2019 and November 2021 of adult participants with or without a planned surgical procedure. The reference standard was tolerance of medication tested during a procedure (NMBA-tolerant group) before ST. Participants received skin prick testing (SPT) and intradermal test (IDT) injections at 5-7 increasing concentrations of 1 or more medications. All medications were reconstituted according to package insert instructions and diluted with 0.9% saline. A concentration was considered irritant when more than 5% of participants had a positive test per ST positivity criteria (wheal ≥3 mm than initial wheal and associated erythema of the same size or greater than wheal). We also compared our results with current guidelines.

Results

A total of 187 participants (78% NMBA-tolerant) underwent 7812 skin tests. All undiluted SPT concentrations were nonirritant. We found the following maximal IDT NICs (mg/mL): cisatracurium (0.02), rocuronium (0.05), succinylcholine (0.8), vecuronium (0.01), neostigmine (0.2), sugammadex (50), and S-R-Cx (sugammadex 7.14 + rocuronium 2).

Conclusion

Our results suggest that SPT may be performed with undiluted stock concentrations. We confirm maximal IDT NICs for cisatracurium and rocuronium. We also propose that currently recommended maximal IDT NICs of succinylcholine, neostigmine, sugammadex, and S-R-Cx could be increased, whereas the maximal IDT NIC of vecuronium could be decreased compared with current guidelines and prior reports.

中文翻译：

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神经肌肉阻滞剂和相关化合物的无刺激性浓度

背景

神经肌肉阻滞剂 (NMBA)、NMBA 逆转剂和舒更葡糖-罗库溴铵包合物 (SR-Cx) 的皮试 (ST) 浓度在报告中差异很大。

客观的

确定 NMBA（顺式阿曲库铵、罗库溴铵、琥珀胆碱和维库溴铵）、NMBA 逆转剂（新斯的明和舒更葡糖）和 SR-Cx 在 NMBA 耐受和 NMBA 初治参与者中的最大 ST 非刺激性浓度 (NIC)。

方法

一项在 2019 年 10 月至 2021 年 11 月期间对有或没有计划手术的成人参与者进行的单中心前瞻性研究。参考标准是在 ST 之前的程序（NMBA 耐受组）期间测试的药物耐受性。参与者接受了5-7 浓度递增的 1 种或多种药物的皮肤点刺试验 (SPT) 和皮内试验(IDT) 注射。所有药物均根据包装说明书重新配制并用 0.9% 盐水稀释。当超过 5% 的参与者根据 ST 阳性标准进行阳性测试（风团比初始风团≥3 毫米，并且相关红斑大小相同或大于风团）时，浓度被认为是刺激性的。我们还将我们的结果与现行指南进行了比较。

结果

共有 187 名参与者（78% 的 NMBA 耐受性）接受了 7812 次皮肤测试。所有未稀释的 SPT 浓度均无刺激性。我们发现以下最大 IDT NIC (mg/mL)：顺式阿曲库铵 (0.02)、罗库溴铵 (0.05)、琥珀酰胆碱 (0.8)、维库溴铵 (0.01)、新斯的明 (0.2)、sugammadex (50) 和SR - Cx (sugammadex 7.14) + 罗库溴铵 2).

结论

我们的结果表明，SPT 可以在未稀释的原液浓度下进行。我们确认了顺式阿曲库铵和罗库溴铵的最大 IDT NIC。我们还建议，与当前指南和之前的报告相比，目前推荐的琥珀胆碱、新斯的明、舒更葡糖和 SR-Cx 的最大 IDT NIC 可以增加，而维库溴铵的最大 IDT NIC 可以降低。