Frequency of occurrence of urticaria after the administration of atracurium

Ajay Kumar, Anil Kumar Jain, Sanjeev Gupta


Background: Atracurium is a non-depolarizing neuromuscular blocking agent generally used for short and intermediate duration surgical procedures. Atracurium may cause urticaria due to direct, non-immunological release of histamine from mast cells.Though cutaneous changes due to histamine release by atracurium have been reported in various studies these changes were not clinically evaluated by dermatologists. The aim of the study was to assess the frequency of occurrence of urticaria after the administration of atracurium in the conventional dose schedule. Haemodynamic changes in pulse rate and mean arterial pressure (MAP) were also evaluated.

Methods: 60 patients aged 12 years and above, undergoing various elective surgical procedures were enrolled in the study. Atracurium was administered in a dose of 0.6 mg/kg body weight after induction. Cutaneous changes if any including erythema and urticarial weals were observed during the intraoperative phase and images recorded for further evaluation by the investigators including dermatologists. Baseline values of pulse rate and MAP as well as values 1 min, 3 min and 5 min after the administration of atracurium were recorded.

Results: None of the patients developed urticarial weals after the administration of atracurium. Five patients (8.33%) developed erythema during the intraoperative period. Changes in pulse rate and MAP were found to be significant.

Conclusions: Atracurium in conventional dosage is not associated with urticaria. Haemodynamic changes after the administration of atracurium are significant. 


Atracurium, Urticaria, Haemodynamic changes

Full Text:



Elbradie S. Neuromuscular efficiency and histamine-release hemodynamic changes produced by rocuronium versus atracurium: a comparative study. J Egypt Natl Canc Inst. 2004;16(2):107-13.

Grattan CEH, Marsland AM. Urticaria. In: Griffiths CEM, Barker J, Bleiker T, Chalmers R, Creamer D, editors. Rook’s Textbook of Dermatology. 9th edition. Oxford: Wiley-Blackwell; 2016;42:1-18.

Hull CJ. Pharmacokinetics and pharmacodynamics of the benzylisoquinolinium muscle relaxants. Acta Anaesthesiol Scand Suppl. 1995;106:13-7.

Saverese JJ, Wastila WB. The future of the benzylisoquinolinium relaxants. Acta Anaesthesiol Scand Suppl. 1995;106;91-3.

Fisher DM, Canfell PC, Fahey MR, Rosen JI, Rupp SM, Sheiner LB, et al. Elimination of atracurium in humans: contribution of Hofmann elimination and ester hydrolysis versus organ-based elimination. Anaesthesiology. 1986;65(1):6-12.

Naguib M, Samarkandi AH, Bakhamees HS, Magboul MA, el-Bakry AK. Histamine-release haemodynamic changes produced by rocuronium, vecuronium, mivacurium, atracurium and tubocurarine. Br J Anaesth. 1995;75(5):588-92.

Movafegh A, Amini S, Sharifnia H, Torkamandi H, Hayatshahi A, Javadi M. Cost analysis and safety comparison of cisatracurium and atracurium in patients undergoing general anesthesia. Eur Rev Med Pharmacol Sci. 2013;17(4):447-50.

Voss J, Reidel T, Sommer M, Rosolski T. Cis-atracurium—an equivalent substitution for atracurium in pediatric anesthesia? Anaesthesiol Reanim. 2002;27(4):93-7.

Doenicke A, Moss J, Lorenz W, Hoernecke R, Gottardis M. Are hypotension and rash after atracurium really caused by histamine release? Anaest Analg. 1994;78(5):967-72.

Shorten GD, Goudsouzian NG, Ali HH. Histamine release following atracurium in the elderly. Anaesthesia. 1993;48(7):568-71.

Doenicke A, Moss J, Lorenz W, Hoernecke R. Intravenous morphine and nalbuphine increase histamine and catecholamine release without accompanying hemodynamic changes. Clin Pharmacol Ther. 1995;58(1):81-9.

El-Kasaby AM, Atef HM, Helmy AM, El-Nasr MA. Cisatracurium in different doses versus atracurium during general anesthesia for abdominal surgery. Saudi J Anaesth. 2010;4(3):152-7.

Loan PB, Elliott P, Mirakhur RK, Bunting HF, Bhanumurthy S, McMurray TJ. Comparison of the haemodynamic effects of mivacurium and atracurium during fentanyl anaesthesia. Br J Anaesth. 1995;74(3):330-2.

Zahoor A, Ahmed N. The effects of duration of Propofol injection on hemodynamics. Middle East J Anaesthesiol. 2010;20(6):845-50.