Perioperative Anaphylaxis: What Should Be Known?

Abstract

Perioperative anaphylaxis is a unique condition as a result of the additive cardiovascular effects of anesthetics on the cardiovascular disturbances of anaphylaxis. It occurs mainly in adulthood, primarily follows anesthetic induction, and for the most part, is an IgE-mediated pathomechanism. Neuromuscular blocking agents (NMBAs) and antibiotics are the main culprit drugs, while latex is now infrequently involved. The Ring and Messmer scale is a useful tool for demonstrating the clinical severity of perioperative immediate hypersensitivity and guiding its management. Grades III and IV are life-threatening and are referred to as anaphylaxis. Three different clinical patterns of grade III may be observed, where cardiovascular collapse is the cardinal sign. Grade IV presents as cardiac arrest. The initial diagnosis is presumptive, whereas the etiological assessment is linked to the clinical presentation, tryptase levels, and skin test results. Since anaphylaxis presents with significant hypovolemia and vasoplegia, aggressive fluid therapy and epinephrine are the cornerstones of management. Whenever possible, anesthetic discontinuation is also recommended. Scientific evidence in favor of preemptive therapeutic strategies to prevent anaphylaxis in the operative setting is lacking.

Hypersensitivity Reactions During Anaesthesia Care: An 11-Year Experience From A Tertiary Hospital

“…Meanwhile, 25,8% of the patients had a grade 3 reaction with important hemodynamic and respiratory consequences, and two entered cardiorespiratory arrest. Since anaphylaxis presents with significant hypovolemia and vasoplegia, aggressive fluid therapy and adrenaline are the cornerstones of management [10]. Despite this fact, in our study adrenaline was only given in 10 patients.…”

“…Immunology and Allergology tests and follow-up are, therefore, of major importance to the investigation of the patients [6,9,10].…”

The Incidence and Nature of Allergic and Anaphylactic Reactions During Pediatric Procedural Sedation: A Report From the Pediatric Sedation Research Consortium

“…2 However, it is likely that the incidence of these events is lower for children than for adults. 7 In a multicenter study from 1993, Murat 8 evaluated 162 551 children undergoing general anesthesia and determined that the incidence of anaphylactic reactions was 1: 7741. However, 76% of these reactions were deemed to be secondary to latex exposure, which currently is an uncommon etiology for anaphylaxis in the operating room given the emphasis on a latex-free environment over the past 2 decades.…”

Association between sugammadex and anaphylaxis in pediatric patients: A nested case‐control study using a national inpatient database

“…We determined whether any of the study patients had asthma or spina bifida or had received preoperative or intraoperative antibiotics, steroids, antihistamine, neuromuscular blocking agents, reversal drugs, or blood transfusions because these are all reportedly potential risk factors for anaphylaxis according to previous studies. [14][15][16][17] We identified asthma and spina bifida by ICD-10 codes J45 and Q05, respectively. Neuromuscular blocking agents included rocuronium, vecuronium, and suxamethonium.…”