Chloroprocaine is suitable for day-case surgery because of faster block regression and discharge than lidocaine. A 500 ml pre-load may not affect discharge but did not increase micturition problems for chloroprocaine.
Background: Despite numerous efforts to describe the clinical manifestations and the epidemiology of perioperative hypersensitivity (POH), there remains room to increase awareness among anesthetists and immunologists/allergists.Objective: To report the findings of a 17-year survey of suspected POH in Antwerp (Belgium).Methods: We analyzed clinical and diagnostic data from 715 patients referred because of a suspected POH reaction, between January 1, 2001 and May 31, 2018. 456 patients demonstrating a POH could be queried about subsequent anesthesia.Results: 608 cases formed the final dataset; 208 had a non-life-threatening reaction, 400 a lifethreatening reaction. In life-threatening reactions, hypotension was predominating. In the non-lifethreatening reactions, 83.9% of the patients displayed cutaneous manifestations. In life-threatening reactions, intravenous adrenaline and fluids were administered in respectively 75.7% and 31%, and 41.3% had their intervention abandoned. Mast cell activation (MCA) was mainly, but not exclusively, observed in severe grades but did not predict the mechanistic process nor the culprit. A cause was identified in 77.8% of severe and 48.6% of milder cases. Main culprits are neuromuscular blocking agents, latex, cefazolin and dyes. 156 had uneventful anesthesia, except one patient who was inadvertently re-exposed to hidden chlorhexidine.Conclusions: This study highlights that there is room for an improved acute management and an optimized diagnostic work-up that should not be restricted to patients with severe reactions and/or showing mast cell activation.
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