Allergien und pseudoallergische Reaktionen auf Narkosemittel

Abstract

Nearly all drugs currently used during the course of general anaesthesia may lead to hypersensitivity reactions of various types. There may be an acute type I allergic reactions or to a more or less severe pseudo-allergic reactions, in rare cases with lethal outcome. Routine preoperative testing appears of little predictive value, in spite of the high frequency of so-called risk factors (atopy, other kind of allergy) among the evaluated group of patients. Careful allergological testing should be performed 4 to 6 weeks after any incidents of suspected drug intolerance, in order to discover the underlying causative agent. Skin testing is of diagnostic value for neuromuscular blockers and intravenous narcotics. RAST- and RIA-tests and/or mediator releasing tests may also used additionally. Together with all other administered drugs, all the routinely used neuromuscular blockers (suxamethonium, vecuronium, pancuronium, alcuronium, atracurium, mivacurium) should be tested, since they often represent the cause for such reactions. For other classes of drugs (for example, volatile anesthetics and opioids) the clinical relevance of skin testing still remains uncertain. For less severe incidents seen during general anaesthesia such as pruritus, or exanthema, skin testing seems to be less relevant.

Anaphylaktische Reaktion auf Sevofluran am Arbeitsplatz

“…Die Autoren gingen aufgrund des zeitlichen Zusammenhanges sowie der Tatsache, dass eine total intravenöse Narkose zwei Wochen später ohne Komplikationen verlief, von einer Anaphylaxie auf Sevofluran aus. Allergologische Testungen waren nicht durchgeführt worden [6]. Ähnlich berichten niederländische Kollegen von einer 7-jährigen Patientin, welche nach Gabe von Halothan und Isofluran mit einem generalisierten Erythem, Bronchospasmus sowie Tachykardie reagiert hatte.…”