Perioperative Anaphylaxis

Abstract

Perioperative anaphylaxis is a life-threatening condition with an estimated prevalence of 1:3,500 to 1:20,000 procedures and a mortality rate of up to 9 %. Clinical presentation involves signs such as skin rash, urticaria, angioedema, bronchospasm, tachycardia, bradycardia, and hypotension. Prompt recognition and treatment is of utmost importance to the patient's prognosis, since clinical deterioration can develop rapidly. Epinephrine is the main treatment drug, and its use should not be postponed, since delayed administration is associated with increased mortality. Elevated levels of serum tryptase help to confirm the diagnosis. The main agents involved in IgE-mediated perioperative anaphylaxis are neuromuscular blocking agents, latex, antibiotics, hypnotics, opioids, and colloids. Specific investigation should be conducted 4 to 6 weeks after the reaction and relies on skin tests, serum-specific IgE, and challenge procedures. This review aims to discuss the main aspects of perioperative anaphylaxis: risk factors, diagnosis, treatment, culprit agents, specific investigation, and preventive measures.

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

“…These results are similar to previous studies, in which the main agents involved in IgE-mediated perioperative anaphylaxis were neuromuscular blocking agents, latex, antibiotics, hypnotics, opioids, and colloids [7,13,14]. In the United States, antibiotics, contrary to NMBAs, were the most common identifiable cause of Perioperative Anaphylaxis [15,16].…”

“…Anaphylaxis during general anaesthesia is a rare but life-threatening clinical condition involving multiple organ systems, and this terminology is usually used when the allergic reaction is associated with cardiovascular collapse or airway obstruction, with or without cutaneous manifestations [3]. Epidemiological studies report a variable incidence of one allergic reaction in 4.000 to 25.000 anesthetic procedures, with overall mortality rate ranging from 0.001% to 9% [1,[4][5][6][7][8][9].…”

Drug-Induced Anaphylaxis

“…It then becomes undetectable, but its metabolites can be measured in urine by taking samples at different time intervals after the episode [59]. Serum tryptase levels peak 60-90 min after the onset of anaphylaxis and can persist for up to 24 h [60,61]. Both parameters can be used to monitor the anaphylactic response.…”

Carcinoid Crisis in a Patient without Previous Carcinoid Syndrome: Perioperative Management and Anesthetics Considerations - A Case Report

“…Although thiopental has a potential to release histamine, the clinical experience has not been adverse [3]. NMB agents have a high degree of cross-reactivity, 65% by skin testing [5] and, if possible, should be avoided [4,6], which was not our case. Remifentanil has a very little potential of histamine release [4] and its infusion provides adequate analgesia with suppression of the intubation stimulus and a rapid titration in order to quickly meet the analgesic requirements during the surgery.…”

“…Ideally, surgery should only be performed when this study is completed, but the risk evaluation should not delay urgent or cancer surgery, like the described case [4]. In addition to the allergic reaction, we have considered the possibility of that episode being a carcinoid crisis as a first manifestation of carcinoid tumor, since many of the clinical features are shared by the two entities (hypotension, cutaneous flushing, bronchospasm, diarrhea [4][5][6]). …”