Hypersensitivity reactions in the anesthesia setting/allergic reactions to anesthetics

Abstract

Hypersensitivity reactions remain a major cause of concern in the perioperative setting. Although largely under-reported, their incidence is higher than previously reported. NMBAs remain the most frequently incriminated drug, followed by latex and antibiotics. The number of reactions involving new allergens like vital dyes or nonsteroidal anti-inflammatory drugs is rapidly increasing. The mechanism of sensitization to NMBAs could be influenced by as yet unidentified environmental factors. The possible role of pholcodine is under investigation. Several guidelines concerning the diagnosis and management of immediate hypersensitivity reactions in anesthesia are now available.

Midazolam and Ketamine Hypersensitivity in a Four Year Old Child

“…Adverse drug reactions have been recognized as one of the most common causes of morbidity and death in anesthesiology practice (1). However, allergic reactions in the anesthesia setting are usually harder to interpret because reactions are usually regarded as toxic, pharmacologic and anesthetic rather than allergic.…”

“…Hypersensitivity reactions in the anesthesia setting are rarer in childhood when compared with adults (1,2). In both children and adults, neuromuscular blocking agents are the most frequently incriminated drugs in this setting followed by antibiotics (2).…”

Two cases of anaphylaxis under anaesthesia with vecuronium

“…5 Most common agents which are responsible for intra-operative anaphylaxis are morphine and almost all muscular agents, in following proportion (succinylcholine 43%, vecuronium 37%, pancuronium 13%, alcuronium 76%, atracurium 6.8%, galamine 56%). 3 The clinical features involve the following: cardiovascular collapse, such as hypotension, tachycardia, or bradycardia; complications of the respiratory system, such as bronchospasm, pulmonary oedema, and hypoxia; and skin reactions, such as systemic lupus erythematosus and oedema, etc. Vascular oedema is a skin change resulting from skin vasodilatation and an increase in vessel wall permeability.…”

Intraoperative Ephedrine Allergy in a Patient Who Received Chemotherapy and Perioperative Hypersensitivity Reactions

“…Serum triptaz artışı sadece mast hücresi degranülasyonunu gösterir. Alerjik veya alerjik olmayan anafilaksi ayrımını göstermemesine rağmen İgE aracılı reaksiyonlarda serum triptaz düzeyinin 25 mcg L -1 'nin üzerinde olduğu ileri sürülmüştür (8). Biyolojik yarılanma ömrü 2 saat olduğun-dan serum triptaz düzeyine 1-6 saat içinde bakılmalıdır.…”

“…Anestezi sırasında, hasta mönitörizedir ve hızlı intravenöz epinefrin uygulamak için intravenöz yol vardır ayrıca anestezist gözetiminde olması erken tanı koyulmasını sağlar. Ancak, reaksiyonun şiddeti ve tedaviye yanıt çok geniş bir diziden olabilir bu nedenle epinefrin uygulanması semptomların şiddeti ile şekillendirilme-lidir (8). Sıvı replasmanı, kortikosteroidler, antihistaminikler, bronkodilatatörler tedaviye destek amacıyla kullanılabilir.…”