Drug-induced anaphylaxis during general anesthesia in 14 tertiary hospitals in Japan: a retrospective, multicenter, observational study

Abstract

Since perioperative anaphylaxis occurs suddenly, and it can be life-threatening, anesthesiologists need to have sufficient knowledge of the epidemiology of perioperative anaphylaxis and appropriate coping strategies to deal with it. Recent studies conducted in Western countries reported the characteristics of perioperative anaphylaxis in each country. However, there are few studies of perioperative anaphylaxis in Japan. To bridge the gap between Japan and other countries, the data of 46 anaphylaxis patients at Gunma University Hospital and 13 neighboring hospitals between 2012 and 2018 were collected and analyzed. The recently developed clinical scoring system was combined with a skin test to include only cases with a definite diagnosis. The most common causative agents were sugammadex, followed by rocuronium, cefazolin, and antibiotics other than cefazolin. Furthermore, the characteristics of anaphylaxis for each causative drug were identified. Time from drug administration to appearance of the first symptom was the longest in the cefazolin group. The incidence of canceled operation was the highest in the rocuronium group. Although it is unclear whether the results of this study can apply to Japan as a whole, the information about the agents responsible for perioperative anaphylaxis and the characteristics of anaphylaxis due to each agent would be helpful to anesthesiologists.

Reply to the letter

“…Certainly, the diagnosis is not easy during induction of general anesthesia because of the multiple drugs administered at this time and the presence of other confounding factors that can lead to hypotension and hypoxia. Reexamination of the characteristics of the cases that occurred at anesthesia induction in our article showed that nine of the 13 cases were caused by rocuronium [2]. In contrast, there was only one case caused by propofol and none by opioids [2].…”

“…Reexamination of the characteristics of the cases that occurred at anesthesia induction in our article showed that nine of the 13 cases were caused by rocuronium [2]. In contrast, there was only one case caused by propofol and none by opioids [2].…”

Incidence of perioperative anaphylaxis in 2021 in Japan: Survey of 34 hospitals of Social Welfare Organization Saiseikai Imperial Gift Foundation, Inc

“…The most common cause was rocuronium use, as corroborated by a previous report. 4 POA because of rocuronium use manifested not only as a type I allergy with specific IgE antibodies, but also through histamine release owing to the stimulation of Mas-related G protein-coupled receptor X2 in mast cells. 6 Hence, the use of this high-risk agent should be carefully considered.…”

“…Only facilities, such as university hospitals, that can dispatch samples for this test participate, which may introduce bias. 4, 5 To our knowledge, no study has included secondary health care providers that do not have an experimental laboratory setup. The Social Welfare Organization Saiseikai Imperial Gift Foundation, Inc. is a group of institutions established for the poor in 1911 by Emperor Meiji.…”

Severe anaphylaxis after general anesthesia induction

“…We read the article by Horiuchi et al [1] with interest. They have reported the data on the agents that cause anaphylaxis during general anesthesia.…”