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

Hertzog, James H.; Preisberga, Krista; Penfil, Scott

doi:10.1542/hpeds.2018-0089

Cited by 17 publications

(10 citation statements)

References 11 publications

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“…However, in connection with a buccal administration of midazolam, a grade 2 anaphylactic reaction had to be treated after a seizure, which did not result in further injury or require intensive medical treatment. This side effect has been published repeatedly ( 27 , 28 ) and is considered as a rare complication of midazolam ( 29 ). Our experience appears to be consistent with the limited data available in the literature.…”

Section: Discussionmentioning

confidence: 92%

Out-of-Hospital Emergencies in Children Under Palliative Home Care

Hauch¹,

Mohaui²,

Wolff

et al. 2021

Front. Pediatr.

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Introduction: Specialized palliative home care (SPHC) enables children and adolescents with life-limiting illnesses and complex needs to receive care at home. In addition to controlling symptoms and stabilizing the psychosocial situation, crisis anticipation is a component of SPHC. Since the establishment of the reporting SPHC team, parents have called for additional help from emergency medical services (EMS) in emergency situations with unexpected frequency. Children with life limiting diseases could undergo invasive procedures and unhelpful treatments with uncertain consequences. The questions arose as to which factors led to the involvement of the EMS in a palliative situation, what therapy was performed and what outcome could be reached.Methods: Records of the pediatric SPHC patients and EMS call-outs in these children of the reporting SPHC-team in the central region of Hesse, Germany (population: 1.1 million) were retrospectively analyzed from 01.11.2014 to 01.05.2021. The causes of the call-outs, the existence of an emergency agreement, the National Advisory Committee for Aeronautics (NACA) score, EMS therapy and outcome were examined. Patient data included age, palliative-justifying diagnosis, duration and intensity of care, place of death and median overall survival (MOS) and palliative SHPC treatment.Results: In total, 172 patients were analyzed during the study period. There were 27 EMS calls for a total of 20 patients/families (= EMS group). Palliative illness or a complication was the most frequent cause of call-outs. The patients in the EMS group were significantly less likely to have a DNR order, required more home visits and telephone calls and were under SPHC care for longer. There was a significantly higher proportion of crisis interventions at home visits. The children in the EMS group died less often from the underlying disease. Of the remaining 152 patients (= non-EMS group), a significantly higher proportion had a European home country.Conclusions: Despite the introduction of the SPHC, parents still call the EMS. Good cooperation and joint training should be sought to prepare all those involved for future call-outs.

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Section: Discussionmentioning

confidence: 92%

Out-of-Hospital Emergencies in Children Under Palliative Home Care

Hauch¹,

Mohaui²,

Wolff

et al. 2021

Front. Pediatr.

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“…Another important difference is that antibiotics were conspicuously absent as potential culprit agents for anaphylaxis in this study. Upon close scrutiny, it is understandable that this was not a specific finding given the founding purpose of this database to include cases for imaging and procedural sedation in off‐sites locations, where these medications would not be frequently used 18 …”

Section: Discussionmentioning

confidence: 99%

Perioperative anaphylaxis in children: A report from the Wake‐Up Safe collaborative

Wakimoto

Miller

Kim

et al. 2021

Pediatric Anesthesia

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Background Anaphylactic reactions to antigens in the perioperative environment are uncommon, but they have a potential to lead to serious morbidity and/or mortality. The incidence of anaphylactic reactions is 1:37 000 pediatric anesthetics, and substantially less than the 1:10 000 to 1:20 000 incidence in the adult population. Neuromuscular blocking agents, latex, and antibiotics are the most frequently cited triggers. To date, there is no comprehensive report on perioperative anaphylactic reactions in children in the United States. Using the Wake‐up Safe database, we examined the incidence and consequences of reported perioperative anaphylaxis events. Methods We reviewed the Wake‐up Safe database from 2010 to 2017 and identified all reported instances of anaphylaxis. The triggering agent, timing, and location of the registered event, severity of patient harm, and preventability were identified. Narrative review of free‐text comments entered by reporting centers was performed to determine presenting symptoms, and interventions required. Type of case was identified from procedure codes provided in mandatory fields. Results Among 2 261 749 cases reported to the Wake‐up Safe database during the study period, perioperative anaphylactic reactions occurred in 1:36 479 (0.003%). Antibiotics, neuromuscular blocking agents, and opioid analgesics were the main triggers. Forty‐nine cases (79%) occurred in the operating room, and 13 cases (21%) occurred in off‐site locations. Seven (11%) patients required cardiopulmonary resuscitation following the onset of symptoms. Thirty‐five (57%) patients were treated with epinephrine or epinephrine plus other medications, whereas 5% were managed only with phenylephrine. Most cases (97%) required escalation of care after the event. Regarding case preventability, 91% of cases were marked as either “likely could not have been prevented” or “almost certainly could not have been prevented.” Conclusion The estimated incidence of anaphylaxis and inciting agents among the pediatric population in this study were consistent with the most recent published studies outside of the United States; however, new findings included need for cardiopulmonary resuscitation in 11% of cases, and estimated fatality of 1.6%. The management of perioperative anaphylaxis could be improved for some cases as epinephrine was not administered, or its administration was delayed. Fewer than half of reported cases had additional investigation to formally identify the responsible agent.

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“…In a recent retrospective analysis, allergic reactions due to sedative e/o analgesic medications during pediatric preprocedural sedation were described with an incidence of about 1:4,219, with midazolam being the third most frequently reported drug (1:2,035) (30). Midazolam can also be associated with severe adverse events, for example, anaphylactic and anaphylactoid reactions (31)(32)(33)(34).…”

Section: Discussionmentioning

confidence: 99%

Case Report: Perioperative Kounis Syndrome in an Adolescent With Congenital Glaucoma

Capponi

Giovannini

Koniari

et al. 2021

Front. Cardiovasc. Med.

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A 12-year-old male patient suffering from congenital glaucoma developed bradycardia, left ventricular failure, and hypotension after induction of anesthesia. Electrocardiography and echocardiography revealed a complete normalization of ECG and a complete spontaneous recovery in the cardiac function 72 hours from the beginning of the clinical manifestations, while cardiac Magnetic Resonance Imaging was performed, and coronary Computed Tomography scan revealed a myocardial bridge of a tract of the left anterior descendent coronary artery. Diagnosis of Kounis syndrome (KS) was made, a relatively novel, under-recognized clinical condition, defined as the manifestation of an acute coronary syndrome accompanied by mast cell activation and platelet aggregation involving interrelated and interacting inflammatory cells in the setting of allergic, hypersensitivity, anaphylactic or anaphylactoid insults. We described one of the first pediatric cases of KS related to anesthetic medications. In children, this syndrome has been only described in isolated case reports or small case series. Thus, it appears critical to report new cases of KS in children to increase the awareness of this disease in pediatric healthcare workers so as to enhance its early recognition and optimal therapeutic strategy. Furthermore, it appears of paramount importance the implementation of universal guidelines accepted by allergology and cardiology societies, in order to standardize the management of pediatric and adult patients with KS. Finally, a close collaboration between pediatric allergists and cardiologists seems fundamental for an optimal multidisciplinary patient care.

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

Cited by 17 publications

References 11 publications

Out-of-Hospital Emergencies in Children Under Palliative Home Care

Out-of-Hospital Emergencies in Children Under Palliative Home Care

Perioperative anaphylaxis in children: A report from the Wake‐Up Safe collaborative

Case Report: Perioperative Kounis Syndrome in an Adolescent With Congenital Glaucoma

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